Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2020008737 | MO |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 53-79278-011 | KS |
NPI | 1457953705 |
---|---|
Provider Name | Mr. Robert Louis Tuttle III |
First Address | Independence, MO 64055-7308 |
Second Address | Independence, MO 64055-7308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2020 |
Last Update Date | 11/11/2020 |