1528331774 NPI number — JULIA MOSES NUTTER CRNP

Table of content: MATTHEW CASTLE (NPI 1891108478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528331774 NPI number — JULIA MOSES NUTTER CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUTTER
Provider First Name:
JULIA
Provider Middle Name:
MOSES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOSES
Provider Other First Name:
JULIA
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528331774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 CARTER DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-5845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-365-2202
Provider Business Mailing Address Fax Number:
844-558-1878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
291 CARTER DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19709-5845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-365-2202
Provider Business Practice Location Address Fax Number:
844-558-1878
Provider Enumeration Date:
02/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  LG-0001275 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: LG-0001275 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R165102 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 238495Y2B . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0524441 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250719365 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250719369 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250721122 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250719303 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".