Provider Demographics
NPI:1164865952
Name:KUTSCHBACH, JULIA ROSE (LVN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ROSE
Last Name:KUTSCHBACH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9012 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2318
Mailing Address - Country:US
Mailing Address - Phone:916-698-6424
Mailing Address - Fax:
Practice Address - Street 1:9012 GROVE ST
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2318
Practice Address - Country:US
Practice Address - Phone:916-698-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244994164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse