Provider Demographics
NPI:1568262616
Name:KUCHTA, ERIN (LPN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KUCHTA
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:RENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:13524 W COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5403
Mailing Address - Country:US
Mailing Address - Phone:845-741-2930
Mailing Address - Fax:
Practice Address - Street 1:617 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-4234
Practice Address - Country:US
Practice Address - Phone:480-955-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ258347164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse