Provider Demographics
NPI:1407284284
Name:LUSTIG, CHRISTINE (RN,MN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LUSTIG
Suffix:
Gender:F
Credentials:RN,MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3634 LORENA DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4238
Mailing Address - Country:US
Mailing Address - Phone:248-247-9208
Mailing Address - Fax:248-874-1501
Practice Address - Street 1:3634 LORENA DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4238
Practice Address - Country:US
Practice Address - Phone:248-247-9208
Practice Address - Fax:248-874-1501
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704125916163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health