Provider Demographics
NPI:1932429487
Name:TUTU, AMY JUDITH (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JUDITH
Last Name:TUTU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 CLOVER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-5400
Mailing Address - Country:US
Mailing Address - Phone:612-804-8579
Mailing Address - Fax:
Practice Address - Street 1:1894 CLOVER MEADOW DR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-5400
Practice Address - Country:US
Practice Address - Phone:612-804-8579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL50364-6164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse