Healthcare Provider Details

I. General information

NPI: 1396329058
Provider Name (Legal Business Name): NUTTER & MOORE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SE 117TH AVE STE 230
VANCOUVER WA
98683-5297
US

IV. Provider business mailing address

601 SE 117TH AVE STE 230
VANCOUVER WA
98683-5297
US

V. Phone/Fax

Practice location:
  • Phone: 360-921-3588
  • Fax:
Mailing address:
  • Phone: 360-921-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DAVID NUTTER
Title or Position: OWNER
Credential:
Phone: 360-921-3588