Healthcare Provider Details

I. General information

NPI: 1174455224
Provider Name (Legal Business Name): TYZERIA LUSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 BERNICE RD APT 1
LANSING IL
60438-1685
US

IV. Provider business mailing address

3125 BERNICE RD APT 1
LANSING IL
60438-1685
US

V. Phone/Fax

Practice location:
  • Phone: 630-381-7755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: