Provider Demographics
NPI:1104271105
Name:MCNUTT, PENELOPE J
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:J
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 LOWER TWIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BLUE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45616-9024
Mailing Address - Country:US
Mailing Address - Phone:740-727-4998
Mailing Address - Fax:
Practice Address - Street 1:912 LOWER TWIN CREEK RD
Practice Address - Street 2:
Practice Address - City:BLUE CREEK
Practice Address - State:OH
Practice Address - Zip Code:45616
Practice Address - Country:US
Practice Address - Phone:740-727-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant