Provider Demographics
NPI:1649936402
Name:LUTZ, SANDRA ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:LUTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BRITTANY LN
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8537
Mailing Address - Country:US
Mailing Address - Phone:847-840-0481
Mailing Address - Fax:
Practice Address - Street 1:411 BRITTANY LN
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-8537
Practice Address - Country:US
Practice Address - Phone:847-840-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041358910163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse