Individual
SHANNON KIRBY LUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
150 DELSEA DR STE B, SEWELL, NJ 08080-9478
(856) 302-0500
Mailing address
401 ROUTE 73 N STE 320, MARLTON, NJ 08053-3426
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00463000
NJ
363AM0700X
Medical Physician Assistant
MA059371
PA
Other
Enumeration date
10/11/2017
Last updated
06/15/2022
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