Provider Demographics
NPI:1487445789
Name:NUTTALL, CHRISTOPHER L
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:NUTTALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NM
Mailing Address - Zip Code:87413-5811
Mailing Address - Country:US
Mailing Address - Phone:505-419-0918
Mailing Address - Fax:
Practice Address - Street 1:414 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-5811
Practice Address - Country:US
Practice Address - Phone:505-419-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician