Healthcare Provider Details

I. General information

NPI: 1417186529
Provider Name (Legal Business Name): CAMMERON LUTRICK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 JULIA ST
RAYVILLE LA
71269-5527
US

IV. Provider business mailing address

1477 FRENCHMANS BEND RD
MONROE LA
71203-8792
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-8833
  • Fax: 318-728-6183
Mailing address:
  • Phone: 318-805-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP05896
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: