Healthcare Provider Details

I. General information

NPI: 1609296839
Provider Name (Legal Business Name): KATHLEEN KUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN KUTZ R.N.

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6477 CENTER ST
MENTOR OH
44060-4109
US

IV. Provider business mailing address

6477 CENTER STREET
MENTOR OH
44060
US

V. Phone/Fax

Practice location:
  • Phone: 440-914-5340
  • Fax: 440-974-5216
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN 251574
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: