Healthcare Provider Details

I. General information

NPI: 1780483289
Provider Name (Legal Business Name): KATELIN LUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 EVANS RD
ZELIENOPLE PA
16063-2905
US

IV. Provider business mailing address

183 EVANS RD
ZELIENOPLE PA
16063-2905
US

V. Phone/Fax

Practice location:
  • Phone: 724-355-7261
  • Fax:
Mailing address:
  • Phone: 724-355-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP036216
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: