Provider Demographics
NPI:1407272982
Name:LUTZ, ANTHONY RICHARD (MSN, A-GNP-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:RICHARD
Last Name:LUTZ
Suffix:
Gender:M
Credentials:MSN, A-GNP-C
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 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:
Practice Address - Street 1:33 OVERLOOK RD STE 301
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3563
Practice Address - Country:US
Practice Address - Phone:908-522-5045
Practice Address - Fax:908-522-5353
Is Sole Proprietor?:No
Enumeration Date:2014-03-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01411500363LA2200X
NC274615163W00000X, 363LA2200X
NYF307178363LA2200X
NY674308163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3205Medicaid
NC1407272982Medicaid
NCNCN310BMedicare PIN
NCNCN310AMedicare PIN