Healthcare Provider Details

I. General information

NPI: 1235497587
Provider Name (Legal Business Name): JENNIFER LOUISE KUTCHER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 07/19/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 W 16TH ST STE B
GREELEY CO
80634-2910
US

IV. Provider business mailing address

5881 W 16TH ST STE B
GREELEY CO
80634-2910
US

V. Phone/Fax

Practice location:
  • Phone: 970-336-1500
  • Fax: 970-652-2937
Mailing address:
  • Phone: 970-336-1500
  • Fax: 970-652-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1165
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0067950
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: