Provider Demographics
NPI:1336597251
Name:LEUTZ, AMELIA (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:LEUTZ
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:MARIE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 CARLETON ST
Mailing Address - Street 2:BUILDING E23
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1323
Mailing Address - Country:US
Mailing Address - Phone:617-253-0566
Mailing Address - Fax:
Practice Address - Street 1:77 MASSACHUSETTS AVE
Practice Address - Street 2:BUILDING E23
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4301
Practice Address - Country:US
Practice Address - Phone:617-253-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2272328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily