Provider Demographics
NPI:1588755268
Name:TUTHILL, KATHERINE A (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:TUTHILL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 OLD ETNA ROAD
Mailing Address - Street 2:SLEEP MEDICINE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766
Mailing Address - Country:US
Mailing Address - Phone:603-650-3630
Mailing Address - Fax:
Practice Address - Street 1:18 OLD ETNA ROAD
Practice Address - Street 2:SLEEP MEDICINE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-650-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN259925363L00000X
NH072289-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2633789Medicaid
NH3102157Medicaid
VT1025596Medicaid
VT1025596Medicaid
OH2633789Medicaid