Healthcare Provider Details

I. General information

NPI: 1679957682
Provider Name (Legal Business Name): GWEN LUTTFRING CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST STE. 240
LIMA OH
45801-3990
US

IV. Provider business mailing address

509 SE 17TH AVE
CAPE CORAL FL
33990-1610
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-2686
  • Fax: 419-996-2687
Mailing address:
  • Phone: 239-772-0111
  • Fax: 239-772-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012145
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.17753-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: