Provider Demographics
NPI:1760178172
Name:GUTENSON, KAITLIN E (PA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:E
Last Name:GUTENSON
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2203 JONES LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2710
Mailing Address - Country:US
Mailing Address - Phone:703-268-3983
Mailing Address - Fax:
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-674-4700
Practice Address - Fax:302-735-3845
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-08-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant