Provider Demographics
NPI:1083922348
Name:UTT, JAMES DANIEL (LPN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DANIEL
Last Name:UTT
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 HOUT RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-1824
Mailing Address - Country:US
Mailing Address - Phone:419-632-1159
Mailing Address - Fax:
Practice Address - Street 1:1985 HOUT RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-1824
Practice Address - Country:US
Practice Address - Phone:419-632-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.124504 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse