Provider Demographics
NPI:1497345482
Name:LUTNER, KATHRYN
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:LUTNER
Suffix:
Gender:F
Credentials:
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 5265
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-0265
Mailing Address - Country:US
Mailing Address - Phone:856-758-7632
Mailing Address - Fax:
Practice Address - Street 1:73 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-5596
Practice Address - Country:US
Practice Address - Phone:856-758-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty