Healthcare Provider Details

I. General information

NPI: 1871732719
Provider Name (Legal Business Name): GINA MARIE KUTTRUS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA MARIE SORRELL

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11245 HURON ST
DENVER CO
80234-2806
US

IV. Provider business mailing address

11139 BAYNE WAY
PARKER CO
80134-3072
US

V. Phone/Fax

Practice location:
  • Phone: 303-457-6605
  • Fax:
Mailing address:
  • Phone: 303-693-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number112221
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: