Provider Demographics
NPI:1174317077
Name:CUTSHALL, LEA ANN MARIE
Entity type:Individual
Prefix:
First Name:LEA ANN
Middle Name:MARIE
Last Name:CUTSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PROFESSIONAL PARK DR STE 21
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6584
Mailing Address - Country:US
Mailing Address - Phone:423-379-8082
Mailing Address - Fax:423-379-8154
Practice Address - Street 1:2 PROFESSIONAL PARK DR STE 21
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6584
Practice Address - Country:US
Practice Address - Phone:423-379-8082
Practice Address - Fax:423-379-8154
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program