Provider Demographics
NPI:1710491964
Name:LUTES, JAYSON JEFFERY (RN)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:JEFFERY
Last Name:LUTES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 W CHILTON AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-4710
Mailing Address - Country:US
Mailing Address - Phone:480-259-8230
Mailing Address - Fax:
Practice Address - Street 1:869 W CHILTON AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-4710
Practice Address - Country:US
Practice Address - Phone:480-259-8230
Practice Address - Fax:480-259-8230
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN103132163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN103132OtherVETERANS ADMINISTRATION