Provider Demographics
NPI:1831720978
Name:LAUTZ, MULU
Entity type:Individual
Prefix:
First Name:MULU
Middle Name:
Last Name:LAUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 S FAIR ST APT 1803
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3658
Mailing Address - Country:US
Mailing Address - Phone:305-780-0715
Mailing Address - Fax:
Practice Address - Street 1:1330 S FAIR ST APT 1803
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3658
Practice Address - Country:US
Practice Address - Phone:305-780-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14810374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide