Healthcare Provider Details

I. General information

NPI: 1750363628
Provider Name (Legal Business Name): DIANNE LOUISE KUTZKE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HOYT AVE
EVERETT WA
98201-4918
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5456
  • Fax: 425-869-7201
Mailing address:
  • Phone: 425-258-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30001181
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: