Basic Information
| Provider Information | |||||||||
| NPI: | 1013272962 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUTLER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654824078 | ||||||||
| FaxNumber: | 8654824960 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654824078 | ||||||||
| FaxNumber: | 8654824960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2012 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APN0000016617 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 1528722 | 05 | TN | MEDICAID |