Provider Demographics
NPI:1831147719
Name:TUTTLE, TERRY LEORA (LPN)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:LEORA
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:TERRY
Other - Middle Name:AERY
Other - Last Name:TUTTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2917 SALEM CAVE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OH
Mailing Address - Zip Code:45613-9768
Mailing Address - Country:US
Mailing Address - Phone:740-226-8021
Mailing Address - Fax:740-226-8021
Practice Address - Street 1:763 DEWEY EXTENSION RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8763
Practice Address - Country:US
Practice Address - Phone:740-820-2995
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH099979164W00000X
OHPN 099979164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2271303Medicaid