Provider Demographics
NPI:1477797793
Name:NUTTER, ROBERT WILLIAM (RN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:NUTTER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8447 CREEKRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-3272
Mailing Address - Country:US
Mailing Address - Phone:916-721-8090
Mailing Address - Fax:
Practice Address - Street 1:8447 CREEKRIDGE CIR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-3272
Practice Address - Country:US
Practice Address - Phone:916-721-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09-0123S146N00000X
CARN 743815163W00000X
CAPHN 75020163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health