Provider Demographics
NPI:1245677632
Name:TUTTLE, JENNIFER LYNN (ND)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-0332
Mailing Address - Country:US
Mailing Address - Phone:802-253-2340
Mailing Address - Fax:802-253-2239
Practice Address - Street 1:645 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4595
Practice Address - Country:US
Practice Address - Phone:802-253-2340
Practice Address - Fax:802-253-2239
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0091046207Q00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020628Medicaid