Healthcare Provider Details

I. General information

NPI: 1528266822
Provider Name (Legal Business Name): DIANE K. KUTTER BS, LCCE, FACCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 EDSEL ST SE
KENTWOOD MI
49508-4610
US

IV. Provider business mailing address

1206 EDSEL ST SE
KENTWOOD MI
49508-4610
US

V. Phone/Fax

Practice location:
  • Phone: 616-531-5274
  • Fax: 616-538-5285
Mailing address:
  • Phone: 616-531-5274
  • Fax: 616-538-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: