Individual
STACEY LYNN LUETMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
23896 N LAKESHORE DR, GLENWOOD, MN 56334-9372
(320) 491-1691
(800) 878-9591
Mailing address
23896 N LAKESHORE DR, GLENWOOD, MN 56334-9372
(320) 491-1691
(800) 878-9591
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
43321
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
398898800
—
MN
01
—
P00305932
RR MEDICARE
MN
Enumeration date
01/18/2006
Last updated
12/23/2022
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