Provider Demographics
NPI:1811040157
Name:TUTTLE, EMMYLOU E (CRNA)
Entity type:Individual
Prefix:MS
First Name:EMMYLOU
Middle Name:E
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:EMMYLOU
Other - Middle Name:E
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3850 CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1017
Mailing Address - Country:US
Mailing Address - Phone:586-377-2808
Mailing Address - Fax:
Practice Address - Street 1:1101 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1863
Practice Address - Country:US
Practice Address - Phone:248-652-5354
Practice Address - Fax:248-652-5861
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704195685367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI430F364550OtherBCBS
MI4469630Medicaid
11911170OtherCAQH
11911170OtherCAQH