Provider Demographics
NPI:1619046125
Name:CUTLER, EDWARD (CRNA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CUTLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N BELL ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-4347
Mailing Address - Country:US
Mailing Address - Phone:402-727-7990
Mailing Address - Fax:402-727-1761
Practice Address - Street 1:1040 N BELL ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-4347
Practice Address - Country:US
Practice Address - Phone:402-727-7990
Practice Address - Fax:402-727-1761
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100698174400000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE911765978-15Medicaid
NE911765978-15Medicaid
NE273694Medicare UPIN