Healthcare Provider Details

I. General information

NPI: 1134012164
Provider Name (Legal Business Name): ANGELES LUTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 RAASCH DR STE 300
NORFOLK NE
68701-3175
US

IV. Provider business mailing address

2613 CLEARFIELD DR
NORFOLK NE
68701-3305
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-3888
  • Fax:
Mailing address:
  • Phone: 402-379-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number139432
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: