Provider Demographics
NPI:1083415491
Name:LUTZ, CHRISTELLA AMOUR (DO)
Entity type:Individual
Prefix:
First Name:CHRISTELLA
Middle Name:AMOUR
Last Name:LUTZ
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 PEBBLE CRK
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9484
Mailing Address - Country:US
Mailing Address - Phone:513-668-6219
Mailing Address - Fax:
Practice Address - Street 1:7316 PEBBLE CRK
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9484
Practice Address - Country:US
Practice Address - Phone:513-668-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385HR2060X, 374U00000X, 385HR2065X
OH600055130322376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No374U00000XNursing Service Related ProvidersHome Health Aide
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child