Provider Demographics
NPI:1144019084
Name:LUELLEN, ROGERS III
Entity type:Individual
Prefix:
First Name:ROGERS
Middle Name:
Last Name:LUELLEN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1949
Mailing Address - Country:US
Mailing Address - Phone:402-306-8957
Mailing Address - Fax:
Practice Address - Street 1:3602 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1949
Practice Address - Country:US
Practice Address - Phone:402-306-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant