Provider Demographics
NPI:1962535823
Name:LUTZ, ANGELA JEAN
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:JEAN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 VILLAGE GREEN DR
Mailing Address - Street 2:APT 11
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701
Mailing Address - Country:US
Mailing Address - Phone:308-882-6136
Mailing Address - Fax:
Practice Address - Street 1:600 SOUTH 13TH STREET
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701
Practice Address - Country:US
Practice Address - Phone:402-370-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator