Individual
AMANDA K LUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7411 HOPE DR STE C, FORT WAYNE, IN 46815-5687
(260) 234-5400
(260) 234-5395
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
71004824A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71004824A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201214450
—
IN
01
—
IN4866027
MEDICARE
IN
Enumeration date
02/24/2014
Last updated
02/02/2023
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