Provider Demographics
NPI:1568730174
Name:STUTES, AMY MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:STUTES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 CHANNEL DR APT 215
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4942
Mailing Address - Country:US
Mailing Address - Phone:805-628-0843
Mailing Address - Fax:
Practice Address - Street 1:3090 CHANNEL DR APT 215
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4942
Practice Address - Country:US
Practice Address - Phone:805-628-0843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN208201164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse