Provider Demographics
NPI:1114585270
Name:LUTZ, HEATHER A (APNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:LUTZ
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N3456 OAKWOOD PASS
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-8857
Mailing Address - Country:US
Mailing Address - Phone:920-470-1444
Mailing Address - Fax:
Practice Address - Street 1:1405 MILL ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-2155
Practice Address - Country:US
Practice Address - Phone:920-531-2400
Practice Address - Fax:920-531-2450
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI196046163W00000X
WI9268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse