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General NPI Number Information
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NPI Number | 1346484235
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Entity Type | Individual
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Provider Name | THERESA JEANNE NUTTLI
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Gender | Female
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 520 RIDGEWOOD DR
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City | METAIRIE
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State | LA
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Zip | 70001-6126
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Country | US
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Telephone | 504-460-0270
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Fax |
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Provider Business Mailing Address
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Address Line | 1978 INDUSTRIAL BLVD
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City | HOUMA
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State | LA
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Zip | 70363-7055
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Country | US
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Telephone | 504-460-0270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD.206812
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License Number State | LA
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