Provider Demographics
NPI:1790407898
Name:NUTT, CHASSIDY DAWN (LPN)
Entity Type:Individual
Prefix:
First Name:CHASSIDY
Middle Name:DAWN
Last Name:NUTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 GRAND PARK DR STE 203
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4049
Mailing Address - Country:US
Mailing Address - Phone:304-422-9293
Mailing Address - Fax:
Practice Address - Street 1:417 GRAND PARK DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-0002
Practice Address - Country:US
Practice Address - Phone:304-422-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39918164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse