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General NPI Number Information
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NPI Number | 1376970327
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Entity Type | Individual
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Provider Name | DIAN NUTTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/06/2013
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Last Update Date | 10/06/2013
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Provider Practice Location Address
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Address Line | 36000 EUCLID AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4625
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Country | US
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Telephone | 440-375-8166
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Fax |
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Provider Business Mailing Address
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Address Line | 4535 DRESSLER RD NW
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City | CANTON
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State | OH
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Zip | 44718-2545
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Country | US
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Telephone | 330-493-4443
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.003858
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License Number State | OH
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