Provider Demographics
NPI:1164509196
Name:KUTRICH, LAURIE A (CD, RD)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:A
Last Name:KUTRICH
Suffix:
Gender:F
Credentials:CD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S. MILLER
Mailing Address - Street 2:CENTRAL WASHINGTON HOSPITAL
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3201
Mailing Address - Country:US
Mailing Address - Phone:509-662-1511
Mailing Address - Fax:
Practice Address - Street 1:1201 S MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3201
Practice Address - Country:US
Practice Address - Phone:509-662-1511
Practice Address - Fax:509-665-6261
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001860133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1164509196Medicaid
WAP01522105OtherRR PTAN
WA1164509196Medicaid
WAG8942631, G8942632Medicare PIN