Provider Demographics
NPI:1457131542
Name:NUTTER, CHARLENE A
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:NUTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BRUSHY FORK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-6704
Mailing Address - Country:US
Mailing Address - Phone:304-476-6019
Mailing Address - Fax:
Practice Address - Street 1:152 BRUSHY FORK RD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-6704
Practice Address - Country:US
Practice Address - Phone:304-476-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant