Healthcare Provider Details

I. General information

NPI: 1942303888
Provider Name (Legal Business Name): DEBORAH LEAH KUTZKO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE EAST PAVILLION 5
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

60 HOOVER ST
BURLINGTON VT
05401-4110
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0013820
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: