Provider Demographics
NPI:1790054468
Name:KUTCHMA, SHELLY LYNN (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:LYNN
Last Name:KUTCHMA
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
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Mailing Address - Street 1:2424 ERWIN RD
Mailing Address - Street 2:SUITE 504, NEONATOLOGY
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3824
Mailing Address - Country:US
Mailing Address - Phone:919-970-9007
Mailing Address - Fax:919-681-6065
Practice Address - Street 1:5524 HOSPITAL N
Practice Address - Street 2:BOX 100500 MEDICAL CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-970-9007
Practice Address - Fax:919-681-6065
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5004705363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal