Provider Demographics
NPI:1093190639
Name:LUTKOFF, REBEKAH (PNP, NPP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:LUTKOFF
Suffix:
Gender:
Credentials:PNP, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 WILTSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4945
Mailing Address - Country:US
Mailing Address - Phone:716-796-9524
Mailing Address - Fax:
Practice Address - Street 1:1404 SWEET HOME RD STE 2
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2778
Practice Address - Country:US
Practice Address - Phone:716-796-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382555363LP0200X
NY406431363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics