Provider Demographics
NPI:1043587538
Name:LUTHER, DELLA R (CHA IV)
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:R
Last Name:LUTHER
Suffix:
Gender:F
Credentials:CHA IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 AAKSAIK
Mailing Address - Street 2:BOX 90
Mailing Address - City:NOATAK
Mailing Address - State:AK
Mailing Address - Zip Code:99761
Mailing Address - Country:US
Mailing Address - Phone:907-485-2161
Mailing Address - Fax:
Practice Address - Street 1:90 AAKSAIK
Practice Address - Street 2:
Practice Address - City:NOATAK
Practice Address - State:AK
Practice Address - Zip Code:99761
Practice Address - Country:US
Practice Address - Phone:907-485-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK00-445-4172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker