Provider Demographics
NPI:1679029920
Name:LUTKER, ROBIN LYNN (:LPN MHP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:LUTKER
Suffix:
Gender:F
Credentials::LPN MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MOUND CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62963-1241
Mailing Address - Country:US
Mailing Address - Phone:618-306-5101
Mailing Address - Fax:618-734-1999
Practice Address - Street 1:1401 WAHSINGTON STREET
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:IL
Practice Address - Zip Code:62914
Practice Address - Country:US
Practice Address - Phone:618-734-2665
Practice Address - Fax:618-734-1999
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.120358164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse