Provider Demographics
NPI:1336858968
Name:KIRUUTA MUTEBI, LUCY N (NURSE)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:N
Last Name:KIRUUTA MUTEBI
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:MRS
Other - First Name:LUCY
Other - Middle Name:KIRUUTA
Other - Last Name:MUTEBI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE
Mailing Address - Street 1:4646 JOHN R ST # CA403
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1916
Mailing Address - Country:US
Mailing Address - Phone:313-576-1000
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R ST # CA403
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse