Healthcare Provider Details

I. General information

NPI: 1063489045
Provider Name (Legal Business Name): KATHERINE JOANNE LUTHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 MONTAUK AVE
NEW LONDON CT
06320-4700
US

IV. Provider business mailing address

819 WORCESTER ST STE 3
SPRINGFIELD MA
01151-1045
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-0711
  • Fax: 860-444-5114
Mailing address:
  • Phone: 413-543-6820
  • Fax: 413-543-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number003368
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number003368
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: