Provider Demographics
NPI:1356001812
Name:LUTZ, JESSIE ERIN (CD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:ERIN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 ULUMALU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4325
Mailing Address - Country:US
Mailing Address - Phone:541-602-9330
Mailing Address - Fax:
Practice Address - Street 1:650 ULUMALU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4325
Practice Address - Country:US
Practice Address - Phone:541-602-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula