Provider Demographics
NPI:1750311809
Name:NUTTER, LAURA H (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:NUTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:IN
Practice Address - Zip Code:47243
Practice Address - Country:US
Practice Address - Phone:812-866-3301
Practice Address - Fax:812-866-3327
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000225569OtherANTHEM BCBS
KY64051410Medicaid
IN080185110OtherRAILROAD MEDICARE
IN200378010AMedicaid
4617783OtherAETNA
IN413015POtherSIHO
IN200378010AMedicaid
KY64051410Medicaid
F90530Medicare UPIN
IN000000225569OtherANTHEM BCBS