MEDICARE: CLAIRE LUETKEMEYER

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
1	363LF0000X	Family Nurse Practitioner	F02201044	MO

General Provider Information

NPI Number	:	1780211169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE LUETKEMEYER

Provider Business Mailing Address
First Line	:	213 MICHELLE DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-0135
Country	:	US
Telephone Number	:	573-864-9996
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 E NORTH ST
Second Line	:
City	:	ELDON
State	:	MO
Zip	:	65026-2634
Country	:	US
Telephone Number	:	443-275-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	09/29/2023

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Directions to “ CLAIRE LUETKEMEYER ” Practice Location

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