Individual
JEANINE LUTGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4521 W HOPI TRL, LAVEEN, AZ 85339-2068
(602) 795-3371
Mailing address
PO BOX 436, LAVEEN, AZ 85339-0436
(602) 795-3371
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3608
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284600
—
AZ
Enumeration date
12/11/2006
Last updated
04/08/2019
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