Basic Information
| Provider Information | |||||||||
| NPI: | 1871673855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUTT | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MS, RD, LMNT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54635 836 1/2 RD | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687155063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023714880 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2700 W NORFOLK AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687014438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023714880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 509 | NE | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 831697 | 01 | CDR | OTHER | 509 | 01 | NE | LMNT | OTHER | 47079687563 | 05 | NE | MEDICAID |