Provider Demographics
NPI:1568153989
Name:HUTZLER, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HUTZLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH JUNCTION
Mailing Address - State:WV
Mailing Address - Zip Code:25442-5012
Mailing Address - Country:US
Mailing Address - Phone:856-842-7367
Mailing Address - Fax:
Practice Address - Street 1:70 5TH ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH JUNCTION
Practice Address - State:WV
Practice Address - Zip Code:25442-5012
Practice Address - Country:US
Practice Address - Phone:856-842-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant