Provider Demographics
NPI:1134368400
Name:DUTKIEWICZ, KATELYN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:DUTKIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:DUTKIEWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:17 RESEARCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2178
Mailing Address - Country:US
Mailing Address - Phone:413-549-8400
Mailing Address - Fax:413-549-8409
Practice Address - Street 1:17 RESEARCH DRIVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2178
Practice Address - Country:US
Practice Address - Phone:413-549-8400
Practice Address - Fax:413-549-8409
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA3740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant