Active NPI
Dianne Louise Kutzke, ARNP
- Family Nurse Practitioner
- Everett, WA
National Provider Identifier
1750363628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP30001181
- Practice address
- 3901 Hoyt Ave
Everett, WA 98201-4918 - Phone
- (425) 339-5456
- Fax
- (425) 869-7201
- NPI assigned
- Nov 16, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP30001181 | WA | Primary |
Addresses
Primary practice location
3901 Hoyt Ave
Everett, WA 98201-4918
Mailing address
PO Box 5127
Everett, WA 98206-5127
Phone (425) 258-3900
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7023KU | Other | WA | BLUE SHIELD |
| 9607276 | Medicaid | WA | |
| 139617 | Other | WA | LABOR & INDUSTRIES |
| 1018078 | Medicaid | WA | |
| 200012131 | Other | WA | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432252800000",
"number": "1750363628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5127",
"city": "EVERETT",
"state": "WA",
"postal_code": "982065127",
"telephone_number": "425-258-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 HOYT AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982014918",
"telephone_number": "425-339-5456",
"fax_number": "425-869-7201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUTZKE",
"first_name": "DIANNE",
"middle_name": "LOUISE",
"name_prefix": "Ms.",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-16",
"last_updated": "2015-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP30001181",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "7023KU",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9607276",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "139617",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1018078",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "200012131",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.