Provider Demographics
NPI:1326888983
Name:GUTTERSOHN, KIRSTEN LINDSEY (AGNP-C)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LINDSEY
Last Name:GUTTERSOHN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1077
Mailing Address - Country:US
Mailing Address - Phone:517-548-9200
Mailing Address - Fax:517-548-9200
Practice Address - Street 1:1320 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1077
Practice Address - Country:US
Practice Address - Phone:517-548-9200
Practice Address - Fax:517-548-9200
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704313055363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health