Provider Demographics
NPI:1710948245
Name:LUEDTKE, JAMES R (INDEPENDENT DUTY HM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:LUEDTKE
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY HM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 INTEGRITY DRIVE
Mailing Address - Street 2:C/O COMMANDER NAVY RECRUITING COMMAND
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38045-5057
Mailing Address - Country:US
Mailing Address - Phone:901-874-9417
Mailing Address - Fax:
Practice Address - Street 1:5722 INTEGRITY DRIVE, BLDG S771
Practice Address - Street 2:NBHC, NSA MID-SOUTH
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054
Practice Address - Country:US
Practice Address - Phone:901-874-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-02
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
USN HM8425-9002247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other