Healthcare Provider Details

I. General information

NPI: 1154620003
Provider Name (Legal Business Name): JAMIE L LUTTRELL CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27401 W HIGHWAY 22 SUITE 125
BARRINGTON IL
60010-5999
US

IV. Provider business mailing address

27401 W HIGHWAY 22 SUITE 125
BARRINGTON IL
60010-5999
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-0388
  • Fax: 847-381-0811
Mailing address:
  • Phone: 847-381-0388
  • Fax: 847-381-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: