Healthcare Provider Details

I. General information

NPI: 1306930235
Provider Name (Legal Business Name): KATHLEEN MARY LUTZ NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST AVE TISCH BUILDING ROOM 820
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

560 1ST AVE TISCH BUILDING ROOM 820
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-0593
  • Fax: 212-263-7875
Mailing address:
  • Phone: 212-263-0593
  • Fax: 212-263-7875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360378
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: