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General NPI Number Information
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NPI Number | 1598067316
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Entity Type | Individual
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Provider Name | LUCILLE FRANCES LUTZ NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 601 JOHN ST BOX 74
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City | KALAMAZOO
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State | MI
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Zip | 49007-5341
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Country | US
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Telephone | 269-341-7339
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 52 48855 59 1/2 STREET
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City | HARTFORD
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State | MI
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Zip | 49057
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Country | US
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Telephone | 269-637-0388
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704228927
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License Number State | MI
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