Provider Demographics
NPI:1285878439
Name:LUTT-CHMIEL, MISTI M (BC-HIS#5863, NE#641)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:M
Last Name:LUTT-CHMIEL
Suffix:
Gender:F
Credentials:BC-HIS#5863, NE#641
Other - Prefix:
Other - First Name:MISTI
Other - Middle Name:
Other - Last Name:CHMIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BC-HIS#5863, NE#641
Mailing Address - Street 1:2215 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5313
Mailing Address - Country:US
Mailing Address - Phone:308-382-9282
Mailing Address - Fax:
Practice Address - Street 1:2215 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5313
Practice Address - Country:US
Practice Address - Phone:308-382-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE#641237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist