Provider Demographics
NPI:1427320159
Name:CHESTNUT, MUTINTA (PMHNP)
Entity type:Individual
Prefix:
First Name:MUTINTA
Middle Name:
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WESTPORT BAY DR APT 102
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6379
Mailing Address - Country:US
Mailing Address - Phone:443-557-8519
Mailing Address - Fax:
Practice Address - Street 1:5009 FRANKFORD AVE APT 832
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5353
Practice Address - Country:US
Practice Address - Phone:410-325-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR252053363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health