MEDICARE: STEPHANIE RENE' LUTTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	141517	LA

General Provider Information

NPI Number	:	1518801109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE RENE' LUTTON

Provider Business Mailing Address
First Line	:	37316 W THORNER RD
Second Line	:
City	:	PEARL RIVER
State	:	LA
Zip	:	70452-5604
Country	:	US
Telephone Number	:	985-960-6428
Fax Number	:

Provider Business Practice Location Address
First Line	:	37316 W THORNER RD
Second Line	:
City	:	PEARL RIVER
State	:	LA
Zip	:	70452-5604
Country	:	US
Telephone Number	:	985-960-6428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ STEPHANIE RENE' LUTTON ” Practice Location

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