Healthcare Provider Details

I. General information

NPI: 1790249340
Provider Name (Legal Business Name): BRITTANY LEE KUTZ BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N1547 COUNTY ROAD K
FORT ATKINSON WI
53538-9362
US

IV. Provider business mailing address

N1547 COUNTY ROAD K
FORT ATKINSON WI
53538-9362
US

V. Phone/Fax

Practice location:
  • Phone: 920-723-6729
  • Fax:
Mailing address:
  • Phone: 920-723-6729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number241742
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: