Provider Demographics
NPI:1336457027
Name:CUTSHALL, RONNIE (LPN)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:
Last Name:CUTSHALL
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 1:405 WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-5674
Mailing Address - Country:US
Mailing Address - Phone:423-948-7305
Mailing Address - Fax:
Practice Address - Street 1:405 WALTERS RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-5674
Practice Address - Country:US
Practice Address - Phone:423-948-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43493164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLPN0000043493OtherTENNESSEE STATE BOARD OF NURSING