Provider Demographics
NPI:1548001605
Name:MCCAW, NUTASHA
Entity type:Individual
Prefix:
First Name:NUTASHA
Middle Name:
Last Name:MCCAW
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 1:634 RIVER BEND CT APT 103
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7066
Mailing Address - Country:US
Mailing Address - Phone:832-805-4397
Mailing Address - Fax:
Practice Address - Street 1:634 RIVER BEND CT APT 103
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7066
Practice Address - Country:US
Practice Address - Phone:832-805-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001325553163WG0000X, 163WH0200X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical