Provider Demographics
NPI:1154924264
Name:MCNUTT, LEAH EVELYN
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:EVELYN
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 1:10356 CLEAR BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8642
Mailing Address - Country:US
Mailing Address - Phone:330-988-0464
Mailing Address - Fax:
Practice Address - Street 1:10356 CLEAR BROOK CIR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8642
Practice Address - Country:US
Practice Address - Phone:330-988-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program