Provider Demographics
NPI:1780838086
Name:CRUTTENDEN, KIM ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:ANN
Last Name:CRUTTENDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HAGEN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2660
Mailing Address - Country:US
Mailing Address - Phone:585-385-6070
Mailing Address - Fax:
Practice Address - Street 1:10 HAGEN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2660
Practice Address - Country:US
Practice Address - Phone:585-385-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304862-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health