Provider Demographics
NPI:1508104811
Name:HEART & SOUL HOUSECALL PROVIDERS, LLC
Entity Type:Organization
Organization Name:HEART & SOUL HOUSECALL PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:306-518-9936
Mailing Address - Street 1:17809 NE 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6120
Mailing Address - Country:US
Mailing Address - Phone:306-518-9936
Mailing Address - Fax:
Practice Address - Street 1:17809 NE 110TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-6120
Practice Address - Country:US
Practice Address - Phone:306-518-9936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60079873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty