Provider Demographics
NPI:1255913943
Name:LUTE, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:LUTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2994 HENLEY COMSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:OTWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45657-9075
Mailing Address - Country:US
Mailing Address - Phone:740-285-5645
Mailing Address - Fax:
Practice Address - Street 1:2994 HENLEY COMSTOCK RD
Practice Address - Street 2:
Practice Address - City:OTWAY
Practice Address - State:OH
Practice Address - Zip Code:45657-9075
Practice Address - Country:US
Practice Address - Phone:740-285-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant