Provider Demographics
NPI:1639758055
Name:LUTHER, NICHOLE ANNE (LMT, CNMT, LPN)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:ANNE
Last Name:LUTHER
Suffix:
Gender:F
Credentials:LMT, CNMT, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9367 BAR B RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-3390
Mailing Address - Country:US
Mailing Address - Phone:719-248-4993
Mailing Address - Fax:
Practice Address - Street 1:631 N WEBER ST STE 320
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1083
Practice Address - Country:US
Practice Address - Phone:719-248-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-04
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN.0334100164W00000X
COMT.0023319225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse