Provider Demographics
NPI:1548086523
Name:LUTTERLOH, JENNIFER ERIN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ERIN
Last Name:LUTTERLOH
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 1:16970 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:LANEXA
Mailing Address - State:VA
Mailing Address - Zip Code:23089-5241
Mailing Address - Country:US
Mailing Address - Phone:757-870-2386
Mailing Address - Fax:
Practice Address - Street 1:16970 STAGE RD
Practice Address - Street 2:
Practice Address - City:LANEXA
Practice Address - State:VA
Practice Address - Zip Code:23089-5241
Practice Address - Country:US
Practice Address - Phone:757-870-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
VA372600000X
VA$$$$$$$$$372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion