Individual
JOHANNAH LUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
202 NW 13TH AVE, PORTLAND, OR 97209-2953
(503) 684-8252
Mailing address
19075 NW TANASBOURNE DR, STE 200, HILLSBORO, OR 97124-5860
(503) 684-8252
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA159810
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA159810
OREGON MEDICAL BOARD
OR
Enumeration date
02/03/2010
Last updated
10/19/2020
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