Healthcare Provider Details

I. General information

NPI: 1326718065
Provider Name (Legal Business Name): HEIDI LYNN KUTTLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33501 1ST WAY S
FEDERAL WAY WA
98003-6208
US

IV. Provider business mailing address

244 S 163RD PL
BURIEN WA
98148-1430
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-2400
  • Fax:
Mailing address:
  • Phone: 206-419-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61212104
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: