Provider Demographics
NPI:1336025048
Name:LUSTEK ANESTHESIA, LLC
Entity type:Organization
Organization Name:LUSTEK ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED REGISTERED NURSE ANESTHET
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:MCKENZIE
Authorized Official - Last Name:LUSTEK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, DNP
Authorized Official - Phone:262-305-8211
Mailing Address - Street 1:W169N11564 BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3283
Mailing Address - Country:US
Mailing Address - Phone:262-305-8211
Mailing Address - Fax:
Practice Address - Street 1:2301 N LAKE DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4508
Practice Address - Country:US
Practice Address - Phone:414-585-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty