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General NPI Number Information
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NPI Number | 1508104811
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Entity Type | Organization
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Legal Business Name | HEART & SOUL HOUSECALL PROVIDERS, LLC
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Dates
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Enumeration Date | 01/21/2013
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Last Update Date | 01/21/2013
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Provider Practice Location Address
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Address Line | 17809 NE 110TH AVE
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City | BATTLE GROUND
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State | WA
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Zip | 98604-6120
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Country | US
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Telephone | 306-518-9936
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Fax |
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Provider Business Mailing Address
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Address Line | 17809 NE 110TH AVE
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City | BATTLE GROUND
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State | WA
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Zip | 98604-6120
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Country | US
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Telephone | 306-518-9936
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | SUZANNE G LUTTS
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Credential | NP
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Telephone | 306-518-9936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP60079873
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License Number State | WA
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