Provider Demographics
NPI:1396224440
Name:MC NUTT, ELYSIA LYNN
Entity Type:Individual
Prefix:
First Name:ELYSIA
Middle Name:LYNN
Last Name:MC NUTT
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 1:1540 MECHANICSVILLE RD APT UP
Mailing Address - Street 2:
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-9523
Mailing Address - Country:US
Mailing Address - Phone:440-969-5713
Mailing Address - Fax:
Practice Address - Street 1:8532 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5822
Practice Address - Country:US
Practice Address - Phone:440-969-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator