Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD457118 | PA |
Y | 2080P0201X | Pediatric Allergist | MD457118 | PA |
NPI | 1780927434 |
---|---|
Provider Name | Dr. Kristen Marie Lutzkanin |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 04/06/2019 |