Provider Demographics
NPI:1336698232
Name:LUTZ, NATHAN (RT(R)(MR)(CT))
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:LUTZ
Suffix:
Gender:M
Credentials:RT(R)(MR)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 HONEYSUCKLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032
Mailing Address - Country:US
Mailing Address - Phone:605-848-5889
Mailing Address - Fax:
Practice Address - Street 1:806 HONEYSUCKLE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-2312
Practice Address - Country:US
Practice Address - Phone:605-848-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3865482471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography