Individual
JACIE LEANN LUTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 36TH ST SE, GRAND RAPIDS, MI 49512-2810
(231) 429-2228
Mailing address
10999 STEGMAN FOREST CT NE, ROCKFORD, MI 49341-7642
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/19/2021
Last updated
04/19/2021
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