Provider Demographics
NPI:1669788378
Name:LUTTRELL, MICHELLE WHETZEL (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:WHETZEL
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:WHETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 CALIFORNIA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2754
Mailing Address - Country:US
Mailing Address - Phone:415-600-3503
Mailing Address - Fax:415-600-3845
Practice Address - Street 1:2300 CALIFORNIA ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2754
Practice Address - Country:US
Practice Address - Phone:415-600-3503
Practice Address - Fax:415-600-3845
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19833363LA2200X
PASP010759363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health