Provider Demographics
NPI:1083587778
Name:FOUTZ, NERESSA GULTIANO (RN)
Entity type:Individual
Prefix:
First Name:NERESSA
Middle Name:GULTIANO
Last Name:FOUTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NERESSA
Other - Middle Name:MEODE
Other - Last Name:GULTIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2426 RICHELIEU AVE SW APT 2
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-3344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2426 RICHELIEU AVE SW APT 2
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-3344
Practice Address - Country:US
Practice Address - Phone:540-566-9593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001239992163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse