Provider Demographics
NPI:1013535202
Name:DRAPER, LUTRENA DIANE
Entity Type:Individual
Prefix:
First Name:LUTRENA
Middle Name:DIANE
Last Name:DRAPER
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 1:8294 BELLOW PARK DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9347
Mailing Address - Country:US
Mailing Address - Phone:614-558-8681
Mailing Address - Fax:
Practice Address - Street 1:8294 BELLOW PARK DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9347
Practice Address - Country:US
Practice Address - Phone:614-558-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN451739163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse