Provider Demographics
NPI:1184481764
Name:NUTTING, DANIELLE (CPRP, CPSS, BA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:NUTTING
Suffix:
Gender:F
Credentials:CPRP, CPSS, BA
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 V
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-0076
Mailing Address - Country:US
Mailing Address - Phone:541-889-1050
Mailing Address - Fax:
Practice Address - Street 1:390 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2513
Practice Address - Country:US
Practice Address - Phone:541-889-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID171M00000X, 175T00000X
ID4880890225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist