Provider Demographics
NPI:1669103990
Name:LUEDTKE, ERIN MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:LUEDTKE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:ROEHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:137 N DATE PALM DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6181
Mailing Address - Country:US
Mailing Address - Phone:480-395-9370
Mailing Address - Fax:
Practice Address - Street 1:1880 W FRYE RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6234
Practice Address - Country:US
Practice Address - Phone:480-395-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ276582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily