Provider Demographics
NPI:1225877145
Name:LUTZ, HANNAH MORGAN (CRNA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MORGAN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11456 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-6524
Mailing Address - Country:US
Mailing Address - Phone:479-567-0309
Mailing Address - Fax:
Practice Address - Street 1:1100 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4419
Practice Address - Country:US
Practice Address - Phone:479-754-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR107107163W00000X
AR148025367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse