Provider Demographics
NPI:1770242976
Name:LUSTER, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:LUSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-4143
Mailing Address - Country:US
Mailing Address - Phone:419-552-0165
Mailing Address - Fax:
Practice Address - Street 1:225 SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4143
Practice Address - Country:US
Practice Address - Phone:419-552-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant