Healthcare Provider Details

I. General information

NPI: 1780211169
Provider Name (Legal Business Name): CLAIRE LUETKEMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E NORTH ST
ELDON MO
65026-2634
US

IV. Provider business mailing address

213 MICHELLE DR
JEFFERSON CITY MO
65109-0135
US

V. Phone/Fax

Practice location:
  • Phone: 443-275-9800
  • Fax:
Mailing address:
  • Phone: 573-864-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02201044
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: