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General NPI Number Information
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NPI Number | 1043025679
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Entity Type | Individual
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Provider Name | BRYAN DUTTMAN MSN, RN, CWOCN
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Gender | Male
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 4420 LAKE BOONE TRL
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City | RALEIGH
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State | NC
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Zip | 27607-7505
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Country | US
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Telephone | 919-784-2048
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 DUNKIRK DR
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City | RALEIGH
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State | NC
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Zip | 27613-4384
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Country | US
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Telephone | 919-333-4867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC2100X
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Taxonomy Name | Continence Care Registered Nurse
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License Number | 275140
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163WX1500X
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Taxonomy Name | Ostomy Care Registered Nurse
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License Number | 275140
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 275140
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License Number State | NC
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