Provider Demographics
NPI:1063959831
Name:LUTTMER, KARENA REGINA (MSOM, LAC)
Entity type:Individual
Prefix:
First Name:KARENA
Middle Name:REGINA
Last Name:LUTTMER
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 POINTE RD APT I23
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4677
Mailing Address - Country:US
Mailing Address - Phone:801-243-0503
Mailing Address - Fax:
Practice Address - Street 1:1592 S 1100 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2454
Practice Address - Country:US
Practice Address - Phone:801-243-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8374247-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist