Individual
KELLIE J LUSTENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
305 W. JACKSON, SUITE 100, NEW HORIZONS OBSTETRICS & GYNECOLOGY, CARBONDALE, IL 62901
(618) 457-0404
(618) 457-0440
Mailing address
305 W JACKSON ST STE 100, CARBONDALE, IL 62901-1474
(618) 457-0404
(618) 457-0440
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209006728
IL
Other
Enumeration date
10/09/2007
Last updated
05/14/2008
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