Provider Demographics
NPI:1568864254
Name:STUTTERHEIM, KRISTI DAWN
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:DAWN
Last Name:STUTTERHEIM
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 1:3200 PLAZA EAST DR
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1607
Mailing Address - Country:US
Mailing Address - Phone:620-663-7628
Mailing Address - Fax:620-665-2647
Practice Address - Street 1:3200 PLAZA EAST DR
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1607
Practice Address - Country:US
Practice Address - Phone:620-663-7628
Practice Address - Fax:620-665-2647
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist