MEDICARE: DEBORAH RENISE NICOLE NUTTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1538751284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH RENISE NICOLE NUTTER

Provider Business Mailing Address
First Line	:	5514 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-2866
Country	:	US
Telephone Number	:	614-805-2972
Fax Number	:	614-604-7836

Provider Business Practice Location Address
First Line	:	5514 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-2866
Country	:	US
Telephone Number	:	614-805-2972
Fax Number	:	614-604-7836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2021
Last Update Date	:	02/04/2021

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Directions to “ DEBORAH RENISE NICOLE NUTTER ” Practice Location

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