Provider Demographics
NPI:1033162409
Name:KUTZBACH, LINDA FAY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:FAY
Last Name:KUTZBACH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:FAY
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:16111 PLUMMER ST
Mailing Address - Street 2:BLDG 99
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2036
Mailing Address - Country:US
Mailing Address - Phone:818-891-7711
Mailing Address - Fax:818-895-5817
Practice Address - Street 1:16111 PLUMMER ST
Practice Address - Street 2:BLDG 99
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2036
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:818-895-5817
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190049163W00000X
CA10245363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190049OtherRN LICENSE