Provider Demographics
NPI:1487834495
Name:LUTJELUSCHE, KRISTI L (RT)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:LUTJELUSCHE
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:L
Other - Last Name:HEIGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10700 E GEDDES AVE
Mailing Address - Street 2:200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:303-761-6278
Practice Address - Street 1:10700 E GEDDES AVE
Practice Address - Street 2:200
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3800
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:303-761-6278
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO339047247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO339047OtherARRT