Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 6632 | MN |
NPI | 1003475013 |
---|---|
Provider Name | Amanda Luthi |
First Address | Benson, MN 56215-1653 |
Second Address | Benson, MN 56215-1653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 12/06/2019 |