Provider Demographics
NPI:1447065313
Name:LUTZ, KAIDENSE W (CNA)
Entity type:Individual
Prefix:
First Name:KAIDENSE
Middle Name:W
Last Name:LUTZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E POPLAR DR APT 109
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-1036
Mailing Address - Country:US
Mailing Address - Phone:605-839-6529
Mailing Address - Fax:
Practice Address - Street 1:503 E POPLAR DR APT 109
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-1036
Practice Address - Country:US
Practice Address - Phone:605-839-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDA053021376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide