MEDICARE: MRS. CYNTHIA MARIE LUTHY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	LE-00034661	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0028252	OH
3	163W00000X	Registered Nurse	RN.370512	OH

General Provider Information

NPI Number	:	1679175384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA MARIE LUTHY FNP-C

Provider Business Mailing Address
First Line	:	2755 SHORELAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-1177
Country	:	US
Telephone Number	:	419-479-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 SHORELAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-1177
Country	:	US
Telephone Number	:	419-479-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	10/12/2024

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