Healthcare Provider Details

I. General information

NPI: 1447831110
Provider Name (Legal Business Name): ERIC J KUTTLER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 EDITH AVE
REDDING CA
96001-3030
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-2882
  • Fax: 530-244-3703
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: