Individual
TANJA LUTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1207 DOVER RD, BLOOMINGTON, IL 61704-7608
(309) 242-7567
Mailing address
1207 DOVER RD, BLOOMINGTON, IL 61704-7608
(309) 242-7567
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
056004223
IL
Other
Enumeration date
07/13/2014
Last updated
07/13/2014
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