Provider Demographics
NPI:1558924662
Name:KUTZ, NANCY (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KUTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 BANTAM RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-3202
Mailing Address - Country:US
Mailing Address - Phone:860-972-6977
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:481 BANTAM RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3202
Practice Address - Country:US
Practice Address - Phone:860-657-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical