Provider Demographics
NPI:1992560569
Name:KOUTNEY, LUZVIMINDA SELGA (FNP-C)
Entity type:Individual
Prefix:
First Name:LUZVIMINDA
Middle Name:SELGA
Last Name:KOUTNEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8152 GENEX WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6207
Mailing Address - Country:US
Mailing Address - Phone:916-831-0404
Mailing Address - Fax:
Practice Address - Street 1:8152 GENEX WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6207
Practice Address - Country:US
Practice Address - Phone:916-831-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029085363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care