Provider Demographics
NPI:1346576998
Name:LUSTINA, COLLEEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:LUSTINA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12334 SPENCER PL
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-6602
Mailing Address - Country:US
Mailing Address - Phone:219-662-9614
Mailing Address - Fax:
Practice Address - Street 1:1000 S COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4855
Practice Address - Country:US
Practice Address - Phone:219-757-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28146913A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily