Basic Information
| Provider Information | |||||||||
| NPI: | 1295363562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUTZ | ||||||||
| FirstName: | JACEY | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1141 ARTESA DR | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700725970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049312152 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045072000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2020 | ||||||||
| LastUpdateDate: | 03/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 86084874 | LA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.