Provider Demographics
NPI:1407169139
Name:UTTER, KRISTENE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTENE
Middle Name:
Last Name:UTTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 GILS WAY
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-8834
Mailing Address - Country:US
Mailing Address - Phone:608-852-7368
Mailing Address - Fax:
Practice Address - Street 1:1248 GILS WAY
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:WI
Practice Address - Zip Code:53528-8834
Practice Address - Country:US
Practice Address - Phone:608-852-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI159042-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse