Provider Demographics
NPI:1053349381
Name:LUTZ, DAWN M (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:LUTZ
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CRNP
Mailing Address - Street 1:1303 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8737
Mailing Address - Country:US
Mailing Address - Phone:330-693-5021
Mailing Address - Fax:
Practice Address - Street 1:20 AMBERWOOD PKWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9765
Practice Address - Country:US
Practice Address - Phone:419-289-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.06993363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2410368Medicaid
OH2410368Medicaid