Individual
TABITHA C LUSTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
521 N YOUNG ST, KENNEWICK, WA 99336-7806
(702) 896-2595
Mailing address
521 N YOUNG ST, KENNEWICK, WA 99336-7806
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
60717984
WA
363LF0000X
Family Nurse Practitioner
APRN001397
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NV
Enumeration date
06/06/2012
Last updated
05/09/2017
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