Provider Demographics
NPI:1376547836
Name:LUETKEMEIER, PATRICIA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:LUETKEMEIER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-2169
Mailing Address - Country:US
Mailing Address - Phone:989-466-0233
Mailing Address - Fax:
Practice Address - Street 1:211 S CRAPO ST
Practice Address - Street 2:STE L
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2961
Practice Address - Country:US
Practice Address - Phone:989-772-1213
Practice Address - Fax:989-772-7147
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704232202363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4998504Medicaid
MI5008754770OtherBCBSM
MI5008754770OtherBCBSM