Healthcare Provider Details

I. General information

NPI: 1770355059
Provider Name (Legal Business Name): MICHELLE NUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 LIMA AVE APT A
DELPHOS OH
45833-2362
US

IV. Provider business mailing address

980 LIMA AVE APT A
DELPHOS OH
45833-2362
US

V. Phone/Fax

Practice location:
  • Phone: 419-605-3000
  • Fax:
Mailing address:
  • Phone: 419-605-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: