Provider Demographics
NPI:1699259002
Name:LUETTGEN, EIRAWEN (ARNP, FNP, ENP)
Entity type:Individual
Prefix:MS
First Name:EIRAWEN
Middle Name:
Last Name:LUETTGEN
Suffix:
Gender:F
Credentials:ARNP, FNP, ENP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 SE MEADOWBROOK BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1756
Mailing Address - Country:US
Mailing Address - Phone:888-227-3312
Mailing Address - Fax:
Practice Address - Street 1:1 TITUS PL
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1457
Practice Address - Country:US
Practice Address - Phone:607-865-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994154-NP363LF0000X
NM56323363LF0000X
WAAP60909551363LF0000X
NY343678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily