Individual
LISA DUTKIEWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
20170 E PENNSYLVANIA AVE, DUNNELLON, FL 34432-6032
(352) 274-7125
Mailing address
24100 SW BEAVER DR, DUNNELLON, FL 34431-3108
(352) 274-7125
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA36477
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C1853
BCBS
FL
Enumeration date
11/01/2010
Last updated
11/01/2010
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