Provider Demographics
NPI:1154674414
Name:NUTTER, TAMMERA L (RN)
Entity Type:Individual
Prefix:MS
First Name:TAMMERA
Middle Name:L
Last Name:NUTTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 42B
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9523
Mailing Address - Country:US
Mailing Address - Phone:304-672-2555
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 42B
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9523
Practice Address - Country:US
Practice Address - Phone:304-672-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54077163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health