Provider Demographics
NPI:1669194858
Name:LUTAC, ANDREA (ND)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:LUTAC
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 179TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6045
Mailing Address - Country:US
Mailing Address - Phone:425-691-0943
Mailing Address - Fax:
Practice Address - Street 1:12911 120TH AVE NE STE E50
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3046
Practice Address - Country:US
Practice Address - Phone:425-820-7700
Practice Address - Fax:425-820-7707
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath