Healthcare Provider Details

I. General information

NPI: 1053743559
Provider Name (Legal Business Name): RACHEL ANNE LUTHEN CPNP - AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA ST
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

748 COVENT DR
KYLE TX
78640-6021
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-2965
  • Fax:
Mailing address:
  • Phone: 512-626-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number769806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: