Provider Demographics
NPI:1619467883
Name:LUTZ, CAROLINE WALKER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:WALKER
Last Name:LUTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9094 E MINERAL CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-7201
Mailing Address - Country:US
Mailing Address - Phone:303-779-5437
Mailing Address - Fax:303-689-9628
Practice Address - Street 1:2352 MEADOWS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8415
Practice Address - Country:US
Practice Address - Phone:303-779-5437
Practice Address - Fax:303-689-9628
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0005362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics