Provider Demographics
NPI:1407553910
Name:NUTTING, NATALIE RENEE (AAS)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:RENEE
Last Name:NUTTING
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1376 SE CONDOR PL
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-6126
Mailing Address - Country:US
Mailing Address - Phone:503-341-2138
Mailing Address - Fax:
Practice Address - Street 1:837 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7617
Practice Address - Country:US
Practice Address - Phone:503-669-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist