Provider Demographics
NPI:1831432194
Name:LUTZ, WAVERLY ANNE (WHNP, CNM)
Entity type:Individual
Prefix:
First Name:WAVERLY
Middle Name:ANNE
Last Name:LUTZ
Suffix:
Gender:F
Credentials:WHNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9340
Mailing Address - Country:US
Mailing Address - Phone:856-589-1414
Mailing Address - Fax:856-256-5772
Practice Address - Street 1:405 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9340
Practice Address - Country:US
Practice Address - Phone:856-589-1414
Practice Address - Fax:856-256-5772
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00053100367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife