Provider Demographics
NPI:1376396184
Name:LUTZ, PETER RICHARD II
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:RICHARD
Last Name:LUTZ
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8444 HAIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:NY
Mailing Address - Zip Code:14012-9615
Mailing Address - Country:US
Mailing Address - Phone:716-622-8685
Mailing Address - Fax:
Practice Address - Street 1:491 HIGH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-4743
Practice Address - Country:US
Practice Address - Phone:716-478-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY838785163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool