Healthcare Provider Details

I. General information

NPI: 1780026336
Provider Name (Legal Business Name): AMITA LUTE GRAHAM CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMITA LUTE HUCKABY

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SUTTER PL STE 203
DAVIS CA
95616-6217
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 530-753-3498
  • Fax: 530-758-2109
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236037
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95011742
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number95100740
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number10725971
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: