Provider Demographics
NPI:1932325008
Name:MUTAI, LUCY CHELAGAT (NURSE)
Entity Type:Individual
Prefix:MS
First Name:LUCY
Middle Name:CHELAGAT
Last Name:MUTAI
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 JETSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-8818
Mailing Address - Country:US
Mailing Address - Phone:614-890-0692
Mailing Address - Fax:
Practice Address - Street 1:3054 JETSTREAM DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-8818
Practice Address - Country:US
Practice Address - Phone:614-890-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse