Provider Demographics
NPI:1801477369
Name:EAST NASHVILLE PEDIATRICS PLLC
Entity type:Organization
Organization Name:EAST NASHVILLE PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-882-4900
Mailing Address - Street 1:1612 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-2536
Mailing Address - Country:US
Mailing Address - Phone:917-846-9609
Mailing Address - Fax:
Practice Address - Street 1:3926 GALLATIN PIKE STE B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-2436
Practice Address - Country:US
Practice Address - Phone:917-846-9609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty