Provider Demographics
NPI:1295532828
Name:NORRIS, LUTHER LEAMEO
Entity type:Individual
Prefix:
First Name:LUTHER
Middle Name:LEAMEO
Last Name:NORRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13056 MARIGOLD ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-1088
Mailing Address - Country:US
Mailing Address - Phone:763-898-6686
Mailing Address - Fax:
Practice Address - Street 1:13056 MARIGOLD ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-1088
Practice Address - Country:US
Practice Address - Phone:763-898-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11146473747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant