Provider Demographics
NPI:1790935146
Name:CUTCHIN, REBECCA K (ANP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:CUTCHIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:K
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:1345 UNITY PL
Practice Address - Street 2:SUITE 135
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5762
Practice Address - Country:US
Practice Address - Phone:765-446-5050
Practice Address - Fax:765-446-5119
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002769A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000610175OtherANTHEM
IN200936450Medicaid
IN200936450Medicaid
IN815150BBBBMedicare PIN