Healthcare Provider Details

I. General information

NPI: 1568262616
Provider Name (Legal Business Name): ERIN KUCHTA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN RENNA LPN

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N SCOTTSDALE RD
SCOTTSDALE AZ
85257-4234
US

IV. Provider business mailing address

13524 W COTTONWOOD ST
SURPRISE AZ
85374-5403
US

V. Phone/Fax

Practice location:
  • Phone: 480-955-0864
  • Fax:
Mailing address:
  • Phone: 845-741-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number258347
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: