Provider Demographics
NPI:1831550318
Name:ZUTZ, ANGELA (125338-30)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ZUTZ
Suffix:
Gender:F
Credentials:125338-30
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-2213
Mailing Address - Country:US
Mailing Address - Phone:920-716-5542
Mailing Address - Fax:
Practice Address - Street 1:751 AIRLINE RD
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-2213
Practice Address - Country:US
Practice Address - Phone:920-716-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI125338-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse