MEDICARE: JACQUELINE R KUTH CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN598921	PA

General Provider Information

NPI Number	:	1215375670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE R KUTH CRNA

Provider Business Mailing Address
First Line	:	PO BOX 737
Second Line	:
City	:	EAST BUTLER
State	:	PA
Zip	:	16029-0737
Country	:	US
Telephone Number	:	724-256-9700
Fax Number	:	724-256-9705

Provider Business Practice Location Address
First Line	:	500 GRANT AVENUE
Second Line	:
City	:	EAST BUTLER
State	:	PA
Zip	:	16029-0737
Country	:	US
Telephone Number	:	724-256-9700
Fax Number	:	724-256-9705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	01/26/2018

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Directions to “ JACQUELINE R KUTH CRNA” Practice Location

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