Provider Demographics
NPI:1144292392
Name:LUTZKE, LYNDA CELESTE (NP)
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:CELESTE
Last Name:LUTZKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S.76 W.19774 SUNNY HILL DR.
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-9235
Mailing Address - Country:US
Mailing Address - Phone:262-679-2399
Mailing Address - Fax:
Practice Address - Street 1:S.76 W.19774 SUNNY HILL DR.
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9235
Practice Address - Country:US
Practice Address - Phone:262-679-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI985-033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43893600Medicaid