MEDICARE: HANNAH NICOLE LUTZ

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1841933207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH NICOLE LUTZ

Provider Business Mailing Address
First Line	:	10152 HIAWATHA DR
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-9533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10152 HIAWATHA DR
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-9533
Country	:	US
Telephone Number	:	616-294-8033
Fax Number	:

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

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	05/02/2022

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Directions to “ HANNAH NICOLE LUTZ ” Practice Location

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