Provider Demographics
NPI:1417186529
Name:LUTRICK, CAMMERON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CAMMERON
Middle Name:
Last Name:LUTRICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 FRENCHMANS BEND RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8792
Mailing Address - Country:US
Mailing Address - Phone:318-805-8624
Mailing Address - Fax:
Practice Address - Street 1:1962 JULIA ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-5527
Practice Address - Country:US
Practice Address - Phone:318-728-8833
Practice Address - Fax:318-728-6183
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1889148Medicaid