Healthcare Provider Details

I. General information

NPI: 1699469270
Provider Name (Legal Business Name): JENNIFER LUTHMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 MARION DR
MARIA STEIN OH
45860-8707
US

IV. Provider business mailing address

830 W MAIN ST
COLDWATER OH
45828-1626
US

V. Phone/Fax

Practice location:
  • Phone: 419-925-5104
  • Fax:
Mailing address:
  • Phone: 419-678-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN.CNP.0030895
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: