Healthcare Provider Details

I. General information

NPI: 1336379064
Provider Name (Legal Business Name): LUETTA KAY ARNESON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 LAFAYETTE ST
PONTIAC MI
48342-2033
US

IV. Provider business mailing address

2830 CORUNNA RD
FLINT MI
48503-3254
US

V. Phone/Fax

Practice location:
  • Phone: 248-338-7458
  • Fax: 248-338-7513
Mailing address:
  • Phone: 810-235-6812
  • Fax: 810-234-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704201246
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: