Healthcare Provider Details

I. General information

NPI: 1568446425
Provider Name (Legal Business Name): LUANN MARIE HINTZE P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUANN MARIE SCHMIDTHUBER

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 1ST ST SE LITTLE FALLS ORTHOPEDICS
LITTLE FALLS MN
56345-3440
US

IV. Provider business mailing address

1108 1ST ST SE LITTLE FALLS ORTHOPEDICS
LITTLE FALLS MN
56345-3440
US

V. Phone/Fax

Practice location:
  • Phone: 320-631-2200
  • Fax: 320-632-3728
Mailing address:
  • Phone: 320-631-2200
  • Fax: 320-632-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9713
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2506
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: