Provider Demographics
NPI:1114152873
Name:LUTZ, DONNA E (CRNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:E
Last Name:LUTZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-0813
Mailing Address - Country:US
Mailing Address - Phone:610-481-0481
Mailing Address - Fax:610-481-0486
Practice Address - Street 1:48 S. FOURTH STREET
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602
Practice Address - Country:US
Practice Address - Phone:610-376-8061
Practice Address - Fax:610-379-8099
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN187433L163W00000X
PATP006878G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse