Healthcare Provider Details

I. General information

NPI: 1598107542
Provider Name (Legal Business Name): AMANDA JEAN KUCHENREUTHER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 KENYON RD
FORT DODGE IA
50501-5742
US

IV. Provider business mailing address

416 ELM ST
ROCKWELL CITY IA
50579-1624
US

V. Phone/Fax

Practice location:
  • Phone: 515-574-8484
  • Fax:
Mailing address:
  • Phone: 515-571-4754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA117926
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: