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General NPI Number Information
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NPI Number | 1750387387
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Entity Type | Individual
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Provider Name | AMBER D LUTZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 1202 W BUENA VISTA RD. SUITE #100
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City | EVANSVILLE
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State | IN
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Zip | 47710-5185
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Country | US
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Telephone | 812-429-1520
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Fax | 812-429-1523
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Provider Business Mailing Address
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Address Line | 1202 W BUENA VISTA RD. SUITE # 100
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City | EVANSVILLE
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State | IN
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Zip | 47710-5185
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Country | US
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Telephone | 812-429-1520
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Fax | 812-429-1523
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085002198
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10000657A
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License Number State | IN
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