Provider Demographics
NPI:1487108890
Name:TRUTZA, KIMBERLY LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:TRUTZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12965 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:OH
Mailing Address - Zip Code:44234-9699
Mailing Address - Country:US
Mailing Address - Phone:216-570-0908
Mailing Address - Fax:
Practice Address - Street 1:25501 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5603
Practice Address - Country:US
Practice Address - Phone:216-545-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020232207X00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery