Provider Demographics
NPI:1184458176
Name:LUTZ, STACIE LYNNETTE (APRN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNNETTE
Last Name:LUTZ
Suffix:
Gender:F
Credentials:APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 AVENUE R
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-7641
Mailing Address - Country:US
Mailing Address - Phone:972-489-1676
Mailing Address - Fax:
Practice Address - Street 1:6051 GARTH RD STE 700
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-9807
Practice Address - Country:US
Practice Address - Phone:281-837-2120
Practice Address - Fax:281-839-7369
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157371363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health