Healthcare Provider Details

I. General information

NPI: 1386424562
Provider Name (Legal Business Name): CHRISTINE MARIE LUSTIG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 DEMPSTER ST
EVANSTON IL
60202-1016
US

IV. Provider business mailing address

3001 N GREENBAY ROAD
NORTH CHICAGO IL
60064
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-8084
  • Fax: 224-610-8595
Mailing address:
  • Phone: 847-688-1900
  • Fax: 224-610-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-272732
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: