Provider Demographics
NPI:1871673855
Name:LUTT, KRISTIN A (MS, RD, LMNT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:LUTT
Suffix:
Gender:F
Credentials:MS, RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54635 836 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:NE
Mailing Address - Zip Code:68715-5063
Mailing Address - Country:US
Mailing Address - Phone:402-371-4880
Mailing Address - Fax:
Practice Address - Street 1:2700 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4438
Practice Address - Country:US
Practice Address - Phone:402-371-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE509133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
831697OtherCDR
NE509OtherLMNT
NE47079687563Medicaid
NE509OtherLMNT
831697OtherCDR