Provider Demographics
NPI:1700388816
Name:KUTTEROFF, DAWN MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:KUTTEROFF
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:COONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1001 CHESTERBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-3805
Mailing Address - Country:US
Mailing Address - Phone:610-576-7500
Mailing Address - Fax:
Practice Address - Street 1:1001 CHESTERBROOK BLVD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312
Practice Address - Country:US
Practice Address - Phone:610-576-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP01819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily