Provider Demographics
NPI:1790056794
Name:LOTT, LUNETTE L (LPN)
Entity Type:Individual
Prefix:MS
First Name:LUNETTE
Middle Name:L
Last Name:LOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46406-1426
Mailing Address - Country:US
Mailing Address - Phone:219-885-4264
Mailing Address - Fax:219-882-0962
Practice Address - Street 1:1100 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1711
Practice Address - Country:US
Practice Address - Phone:219-885-4264
Practice Address - Fax:219-882-0962
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27049952A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN27049952AOtherINDIANA PROFESSIONAL LICENSING AGENCY