Basic Information
| Provider Information | |||||||||
| NPI: | 1417110933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUTTEN | ||||||||
| FirstName: | JOHNNILYN | ||||||||
| MiddleName: | GISELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, MS, CRNP-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19905 IVORYTON PL | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY VILLAGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208864903 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9909 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208506361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408646000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2008 | ||||||||
| LastUpdateDate: | 04/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R165559 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 163WR0400X | R165559 | MD | N | Nursing Service Providers | Registered Nurse | Rehabilitation |
No ID Information.