Individual
CHEYENNE LEIGH LUSTILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3610 23RD AVE E, HIBBING, MN 55746-3556
(218) 969-0956
Mailing address
3610 23RD AVE E, HIBBING, MN 55746-3556
(218) 969-0956
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
1105450
MN
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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