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General NPI Number Information
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NPI Number | 1598719932
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Entity Type | Individual
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Provider Name | NICOLE K. LUETKE DO
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Gender | Female
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 11/15/2018
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Provider Practice Location Address
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Address Line | 721 SKIPPACK PIKE SUITE 3
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City | BLUE BELL
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State | PA
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Zip | 19422-1700
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Country | US
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Telephone | 215-793-0600
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Fax | 215-793-0759
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Provider Business Mailing Address
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Address Line | PO BOX 789967
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City | PHILADELPHIA
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State | PA
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Zip | 19178-9967
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Country | US
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Telephone | 484-622-7395
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Fax | 484-622-7399
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS012680
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License Number State | PA
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