Healthcare Provider Details

I. General information

NPI: 1225115009
Provider Name (Legal Business Name): MARY E TUTTLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STEVENS ST
NORWALK CT
06850-3852
US

IV. Provider business mailing address

90 HURLBUTT ST
WILTON CT
06897-3214
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2292
  • Fax: 203-855-3985
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128952
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number003415
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP128952
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR50002
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: