Provider Demographics
NPI:1770252579
Name:ZUTTER, TIA
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:ZUTTER
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 1:41632 206TH ST
Mailing Address - Street 2:
Mailing Address - City:IROQUOIS
Mailing Address - State:SD
Mailing Address - Zip Code:57353-6716
Mailing Address - Country:US
Mailing Address - Phone:605-290-4385
Mailing Address - Fax:
Practice Address - Street 1:41632 206TH ST
Practice Address - Street 2:
Practice Address - City:IROQUOIS
Practice Address - State:SD
Practice Address - Zip Code:57353-6716
Practice Address - Country:US
Practice Address - Phone:605-290-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR055121163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse