Provider Demographics
NPI:1932211059
Name:LUTZ-MCCAIN, STACEY J (CRNP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:J
Last Name:LUTZ-MCCAIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:J
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:12281 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-1276
Mailing Address - Country:US
Mailing Address - Phone:814-734-4182
Mailing Address - Fax:
Practice Address - Street 1:135 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1559
Practice Address - Country:US
Practice Address - Phone:814-860-2361
Practice Address - Fax:814-860-2356
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP00516B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily