Provider Demographics
NPI:1548540610
Name:LUTZ, MONICA JANE (PA-C)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:JANE
Last Name:LUTZ
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:901 KIMOLE LN
Mailing Address - Street 2:B-1
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1491
Mailing Address - Country:US
Mailing Address - Phone:517-263-6733
Mailing Address - Fax:517-263-7148
Practice Address - Street 1:901 KIMOLE LN
Practice Address - Street 2:B-1
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1491
Practice Address - Country:US
Practice Address - Phone:517-263-6733
Practice Address - Fax:517-263-7148
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004628363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical