Provider Demographics
NPI:1164816682
Name:KUTCHENRIDER, NICOLE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:KUTCHENRIDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1181 OLD COUNTRY RD
Mailing Address - Street 2:STE 3
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5018
Mailing Address - Country:US
Mailing Address - Phone:516-931-2320
Mailing Address - Fax:516-931-5734
Practice Address - Street 1:1181 OLD COUNTRY RD
Practice Address - Street 2:STE 3
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5018
Practice Address - Country:US
Practice Address - Phone:516-931-2320
Practice Address - Fax:516-931-5734
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017096363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical