Provider Demographics
NPI:1700037330
Name:LUTZ, WHITNEY GLYN (CPNP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:GLYN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5813
Mailing Address - Country:US
Mailing Address - Phone:207-873-5437
Mailing Address - Fax:207-861-5448
Practice Address - Street 1:159 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5813
Practice Address - Country:US
Practice Address - Phone:207-873-5437
Practice Address - Fax:207-861-5448
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER025780363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics