1336597251 NPI number — AMELIA LEUTZ R.N., F.N.P.-B.C.

Table of content: AMELIA LEUTZ R.N., F.N.P.-B.C. (NPI 1336597251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336597251 NPI number — AMELIA LEUTZ R.N., F.N.P.-B.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEUTZ
Provider First Name:
AMELIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N., F.N.P.-B.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KELLER
Provider Other First Name:
AMELIA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336597251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 CARLETON ST
Provider Second Line Business Mailing Address:
BUILDING E23
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02142-1323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-253-0566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
BUILDING E23
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02139-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-253-0566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN2272328 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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