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NPI Code Detail

MEDICARE: KARENA REGINA LUTTMER MSOM, L.AC

MEDICARE:   KARENA REGINA LUTTMER  MSOM, L.AC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturist8374247-1201UT

General Provider Information

NPI Number : 1063959831
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARENA REGINA LUTTMER MSOM, L.AC
Provider Business Mailing Address
First Line : 8350 POINTE RD APT I23
Second Line :
City : PARK CITY
State : UT
Zip : 84098-4677
Country : US
Telephone Number : 801-243-0503
Fax Number :
Provider Business Practice Location Address
First Line : 1592 S 1100 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-2454
Country : US
Telephone Number : 801-243-0503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2017
Last Update Date : 01/31/2017

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Directions to “ KARENA REGINA LUTTMER MSOM, L.AC” Practice Location

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