Provider Demographics
NPI:1730916388
Name:STUTZ, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STUTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MASTRUZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:GLEN SPEY
Mailing Address - State:NY
Mailing Address - Zip Code:12737-0075
Mailing Address - Country:US
Mailing Address - Phone:845-775-9986
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 75
Practice Address - Street 2:
Practice Address - City:GLEN SPEY
Practice Address - State:NY
Practice Address - Zip Code:12737-0075
Practice Address - Country:US
Practice Address - Phone:845-775-9986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632047163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice