Provider Demographics
NPI:1831473958
Name:TUTTLE, CLARA J (LPN)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:J
Last Name:TUTTLE
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 1:1363 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13411-3823
Mailing Address - Country:US
Mailing Address - Phone:607-847-8402
Mailing Address - Fax:
Practice Address - Street 1:1363 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411-3823
Practice Address - Country:US
Practice Address - Phone:607-847-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261129164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY261129OtherLPN