Provider Demographics
NPI:1679957682
Name:LUTTFRING, GWEN (CNP)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:LUTTFRING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1610
Mailing Address - Country:US
Mailing Address - Phone:239-772-0111
Mailing Address - Fax:239-772-0267
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:STE. 240
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3990
Practice Address - Country:US
Practice Address - Phone:419-996-2686
Practice Address - Fax:419-996-2687
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012145363LF0000X
OHCOA.17753-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily