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General NPI Number Information
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NPI Number | 1851531800
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Entity Type | Individual
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Provider Name | MICHAEL S LUTTRELL NP, PHD
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Gender | Male
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 101 PROFESSIONAL PARK STE A
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City | OXFORD
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State | NC
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Zip | 27565-2580
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Country | US
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Telephone | 919-693-3972
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Fax |
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Provider Business Mailing Address
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Address Line | 208 SILVER PINE CT
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City | DURHAM
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State | NC
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Zip | 27713-9266
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Country | US
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Telephone | 919-593-6086
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201861
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 122695
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License Number State | WI
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