Provider Demographics
NPI:1588143440
Name:LUETGER, JESSICA JOYCE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOYCE
Last Name:LUETGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 WIBLE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-9503
Mailing Address - Country:US
Mailing Address - Phone:661-364-9803
Mailing Address - Fax:419-793-5679
Practice Address - Street 1:9400 WIBLE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-9503
Practice Address - Country:US
Practice Address - Phone:661-364-9803
Practice Address - Fax:419-793-5679
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver