1790056794 NPI number — MS. LUNETTE L LOTT LPN

Table of content: MS. LUNETTE L LOTT LPN (NPI 1790056794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790056794 NPI number — MS. LUNETTE L LOTT LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOTT
Provider First Name:
LUNETTE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790056794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 TOMPKINS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46406-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-885-4264
Provider Business Mailing Address Fax Number:
219-882-0962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 W 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46402-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-885-4264
Provider Business Practice Location Address Fax Number:
219-882-0962
Provider Enumeration Date:
01/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  27049952A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 27049952A . This is a "INDIANA PROFESSIONAL LICENSING AGENCY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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