Individual
RANDI AMANDA LUTHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
555 E BROADWAY AVE STE 229, JACKSON, WY 83001-8640
(307) 739-7665
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-7665
(307) 739-4940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA731
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134630064
—
UT
05
—
1134630064
—
WY
01
—
W31153
WYOMING
—
Enumeration date
10/18/2017
Last updated
06/10/2022
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