Healthcare Provider Details

I. General information

NPI: 1114152873
Provider Name (Legal Business Name): DONNA E LUTZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 S. FOURTH STREET
READING PA
19602
US

IV. Provider business mailing address

PO BOX 813
TREXLERTOWN PA
18087-0813
US

V. Phone/Fax

Practice location:
  • Phone: 610-376-8061
  • Fax: 610-379-8099
Mailing address:
  • Phone: 610-481-0481
  • Fax: 610-481-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN187433L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberTP006878G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: