Healthcare Provider Details

I. General information

NPI: 1871554253
Provider Name (Legal Business Name): CHERYL J UTTECH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER
MADISON WI
53705-2254
US

IV. Provider business mailing address

8007 EXCELSIOR DRIVE
MADISON WI
53717
US

V. Phone/Fax

Practice location:
  • Phone: 608-287-2770
  • Fax: 608-833-6932
Mailing address:
  • Phone: 608-829-5201
  • Fax: 608-833-6932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number73003
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: