Provider Demographics
NPI:1467268482
Name:LUSTER, PAULETTE EVANGELINE
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:EVANGELINE
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 1:7516 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-3338
Mailing Address - Country:US
Mailing Address - Phone:216-767-3046
Mailing Address - Fax:
Practice Address - Street 1:7516 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3338
Practice Address - Country:US
Practice Address - Phone:216-767-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program