Provider Demographics
NPI:1215375670
Name:KUTH, JACQUELINE R (CRNA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:KUTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:EAST BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16029-0737
Mailing Address - Country:US
Mailing Address - Phone:724-256-9700
Mailing Address - Fax:724-256-9705
Practice Address - Street 1:500 GRANT AVENUE
Practice Address - Street 2:
Practice Address - City:EAST BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16029-0737
Practice Address - Country:US
Practice Address - Phone:724-256-9700
Practice Address - Fax:724-256-9705
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN598921367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered