Provider Demographics
NPI:1255618971
Name:FYFFE-WOOTEN, ANTHONY CLIFFORD (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CLIFFORD
Last Name:FYFFE-WOOTEN
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 WYNDEMERE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2465
Mailing Address - Country:US
Mailing Address - Phone:937-985-2761
Mailing Address - Fax:
Practice Address - Street 1:142 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1628
Practice Address - Country:US
Practice Address - Phone:203-998-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-374937163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse