Provider Demographics
NPI:1699853853
Name:NELSON-TUTTLE, CHRISTINE (PNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:NELSON-TUTTLE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0050
Mailing Address - Fax:716-323-0296
Practice Address - Street 1:1001 MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0050
Practice Address - Fax:716-323-0296
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380330363LP0200X
NY398785163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0014387840001OtherPA MEDICAID
NY000560358001OtherBC/BS
NY3905807OtherIHA
NY01917720Medicaid
NY040426001548OtherFIDELIS
NY00027169201OtherUNIVERA
NY3905807OtherIHA