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General NPI Number Information
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NPI Number | 1871216051
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Entity Type | Individual
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Provider Name | NICHOLE CHRISTINE DUTTER APNP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 502 HWY 67
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City | KIEL
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State | WI
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Zip | 53042-1650
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 630 LAKE DR
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City | RANDOM LAKE
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State | WI
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Zip | 53075-1766
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Country | US
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Telephone | 920-912-3742
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13138-33
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License Number State | WI
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