Basic Information
| Provider Information | |||||||||
| NPI: | 1558924662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUTZ | ||||||||
| FirstName: | NANCY | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 481 BANTAM RD | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067593202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609726977 | ||||||||
| FaxNumber: | 8609727040 | ||||||||
| Practice Location | |||||||||
| Address1: | 481 BANTAM RD | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067593202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606571263 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2019 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
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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 | 363AM0700X | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.