Provider Demographics
NPI:1770084873
Name:LUTHY, JOHANNA LYNNE (RNFA)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LYNNE
Last Name:LUTHY
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:LAHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2668 MONTARA DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-2170
Mailing Address - Country:US
Mailing Address - Phone:541-816-4270
Mailing Address - Fax:541-779-4824
Practice Address - Street 1:2668 MONTARA DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-2170
Practice Address - Country:US
Practice Address - Phone:541-816-4270
Practice Address - Fax:541-779-4824
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099000623RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant