Healthcare Provider Details

I. General information

NPI: 1407976137
Provider Name (Legal Business Name): NANCY ATWELL TUTTLE ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PLAGEMAN BLDG OREGON STATE UNIVERSITY
CORVALLIS OR
97331-8567
US

IV. Provider business mailing address

201 PLAGEMAN BLDG OREGON STATE UNIVERSITY
CORVALLIS OR
97331-8567
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-9355
  • Fax: 541-737-9665
Mailing address:
  • Phone: 541-737-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number08466063
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: