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Individual
MRS. TIFFANY DAWN LUTTRELL
Active
Individual
MRS. TIFFANY DAWN LUTTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
652703
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP120053
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280097104
—
TX
05
—
280097105
—
TX
01
—
291790YN3X
MEDICARE
TX
01
—
291790YQ8A
MEDICARE
TX
01
—
75-0818167-015
TRICARE
TX
01
—
75-2771569-008
TRICARE
TX
01
—
8512UE
BCBS
TX
01
—
P01196965
RAIL ROAD
TX
01
—
P01877246
MEDICARE RAIL ROAD
TX
Enumeration date
03/02/2011
Last updated
11/22/2019
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