Provider Demographics
NPI:1437195237
Name:MCNUTT, BRENDA L (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15181 BIG KNOB RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-4949
Mailing Address - Country:US
Mailing Address - Phone:276-676-7127
Mailing Address - Fax:276-676-9366
Practice Address - Street 1:351 COURT ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2921
Practice Address - Country:US
Practice Address - Phone:276-676-7127
Practice Address - Fax:276-676-9366
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024053404367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAR11463Medicare UPIN
VA003447J53Medicare ID - Type Unspecified