Provider Demographics
NPI:1558586586
Name:LUTTRELL, SHELL A (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:SHELL
Middle Name:A
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 E LYNWOOD
Mailing Address - Street 2:531 E. LYNWOOD ST
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:602-242-4446
Mailing Address - Fax:602-626-3555
Practice Address - Street 1:531 E LYNWOOD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1626
Practice Address - Country:US
Practice Address - Phone:602-242-4446
Practice Address - Fax:602-626-3555
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM148176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife