Provider Demographics
NPI:1790935146
Name:CUTCHIN, REBECCA K (ANP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:CUTCHIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:K
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-502-4015
Practice Address - Fax:765-502-4016
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002769A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000610175OtherANTHEM
IN200936450Medicaid
IN200936450Medicaid
IN815150BBBBMedicare PIN