Healthcare Provider Details

I. General information

NPI: 1619766763
Provider Name (Legal Business Name): LEANNE LYNNE LUTZ MSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HIGHLAND AVE RM 4159
MADISON WI
53705-2202
US

IV. Provider business mailing address

701 HIGHLAND AVE RM 4159
MADISON WI
53705-2202
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-5200
  • Fax:
Mailing address:
  • Phone: 608-263-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number226425-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: