Provider Demographics
NPI:1538751284
Name:NUTTER, DEBORAH RENISE NICOLE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RENISE NICOLE
Last Name:NUTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-2866
Mailing Address - Country:US
Mailing Address - Phone:614-805-2972
Mailing Address - Fax:614-604-7836
Practice Address - Street 1:5514 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2866
Practice Address - Country:US
Practice Address - Phone:614-805-2972
Practice Address - Fax:614-604-7836
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist