Healthcare Provider Details

I. General information

NPI: 1689622219
Provider Name (Legal Business Name): STEPHANIE L KUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 BURT CIR
OMAHA NE
68114-2094
US

IV. Provider business mailing address

10506 BURT CIR
OMAHA NE
68114-2094
US

V. Phone/Fax

Practice location:
  • Phone: 402-493-4444
  • Fax:
Mailing address:
  • Phone: 402-493-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00018817
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number24380
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36756
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: