Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2000158996 | MO |
N | 363LC1500X | Nurse Practitioner - Community Health | 2000158996 | MO |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2000158996 | MO |
N | 363LP2300X | Nurse Practitioner - Primary Care | 2000158996 | MO |
NPI | 1982898326 |
---|---|
Provider Name | Cassandra L Lutes |
First Address | Troy, MO 63379-4423 |
Second Address | Troy, MO 63379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 03/06/2018 |