Provider Demographics
NPI:1013992080
Name:NUTTING, AMY L (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:NUTTING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:EISAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:650 SHAWAN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2100
Mailing Address - Country:US
Mailing Address - Phone:614-764-1711
Mailing Address - Fax:614-889-2652
Practice Address - Street 1:650 SHAWAN FALLS DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2100
Practice Address - Country:US
Practice Address - Phone:614-764-1711
Practice Address - Fax:614-889-2652
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1351OtherRR MEDICARE GRP ID
OH50001728OtherP.A. STATE LICENSE
OH1351OtherRR MEDICARE GRP ID
OHQ69630Medicare UPIN
OHPA26911Medicare PIN