Provider Demographics
NPI:1417264581
Name:KUTZ, JARUSHA (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:JARUSHA
Middle Name:
Last Name:KUTZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 NE 15TH AVE # 576
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2356
Mailing Address - Country:US
Mailing Address - Phone:503-683-2109
Mailing Address - Fax:971-245-1736
Practice Address - Street 1:1172 NE MORTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-4158
Practice Address - Country:US
Practice Address - Phone:503-683-2109
Practice Address - Fax:971-245-1736
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050166NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health