Provider Demographics
NPI:1003121468
Name:LUETKE, JEANNE (RD)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:LUETKE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0622
Mailing Address - Country:US
Mailing Address - Phone:970-309-0784
Mailing Address - Fax:866-335-0877
Practice Address - Street 1:825 GRAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3403
Practice Address - Country:US
Practice Address - Phone:970-309-0784
Practice Address - Fax:866-335-0877
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
00726643OtherAMERICAN DIETETIC ASSOC / COMMISSION ON DIETETIC REGISTRATION