Healthcare Provider Details

I. General information

NPI: 1700388816
Provider Name (Legal Business Name): DAWN MARIE KUTTEROFF CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN MARIE COONEY CRNP

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CHESTERBROOK BLVD
BERWYN PA
19312
US

IV. Provider business mailing address

1001 CHESTERBROOK BLVD
BERWYN PA
19312-3805
US

V. Phone/Fax

Practice location:
  • Phone: 610-576-7500
  • Fax:
Mailing address:
  • Phone: 610-576-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP01819
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: