Provider Demographics
NPI:1922633957
Name:NUTTER, MADISON J (PA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:J
Last Name:NUTTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 N LINCOLN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1072
Mailing Address - Country:US
Mailing Address - Phone:402-362-5044
Mailing Address - Fax:402-362-7137
Practice Address - Street 1:2114 N LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1072
Practice Address - Country:US
Practice Address - Phone:402-362-5044
Practice Address - Fax:402-362-7137
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine