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NPI Code Detail

MEDICARE: BRENNA SUE LUTHY

MEDICARE: BRENNA SUE LUTHY
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
13245S0500XChildren's Substance Abuse Rehabilitation FacilityUT

General Provider Information

NPI Number : 1629738281
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENNA SUE LUTHY
Provider Business Mailing Address
First Line : 66 N 180 W
Second Line :
City : EPHRAIM
State : UT
Zip : 84627-2130
Country : US
Telephone Number : 435-283-0164
Fax Number :
Provider Business Practice Location Address
First Line : 66 N 180 W
Second Line :
City : EPHRAIM
State : UT
Zip : 84627-2130
Country : US
Telephone Number : 435-283-0164
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2021
Last Update Date : 12/23/2021

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Directions to “ BRENNA SUE LUTHY ” Practice Location

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