Healthcare Provider Details

I. General information

NPI: 1992774947
Provider Name (Legal Business Name): GREGORY L TUTTLE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 FARAON ST
SAINT JOSEPH MO
64506-3488
US

IV. Provider business mailing address

1301 PLEASANT HILL DR
PLATTE CITY MO
64079-9686
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-6350
  • Fax: 816-271-6753
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number084836
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number084836
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: