Individual
MRS. JESSICA CLAIRE LUTKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
10012 KENNERLY RD STE 400, SAINT LOUIS, MO 63128-2197
(314) 543-5999
(314) 543-5994
Mailing address
1223 N RAPP AVE, COLUMBIA, IL 62236-1125
(618) 340-1869
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2014039582
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
2020034593
MO
Other
Enumeration date
10/12/2020
Last updated
10/22/2020
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