Individual
JODI R LUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1650 WASHINGTON AVE, ALTON, IL 62002-3931
(314) 687-2735
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209017496
IL
363LF0000X
Family Nurse Practitioner
2018006031
MO
363LF0000X
Family Nurse Practitioner
209017496
IL
Other
Enumeration date
09/24/2018
Last updated
10/23/2020
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