Provider Demographics
NPI:1487908729
Name:TUTTLE, ELIZABETH (DOM)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FREDS LOOP
Mailing Address - Street 2:PO BOX 1012
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552-1012
Mailing Address - Country:US
Mailing Address - Phone:505-757-2140
Mailing Address - Fax:
Practice Address - Street 1:16 FREDS LOOP
Practice Address - Street 2:BOX 1012
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552-1012
Practice Address - Country:US
Practice Address - Phone:505-757-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM735171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist