Wanda W Tutt, LRD | |
333 Revolutionary Trl, Fairfax, SC 29827-7109 | |
(803) 632-2533 | |
(803) 632-3757 |
Full Name | Wanda W Tutt |
---|---|
Gender | Female |
Speciality | Dietitian, Registered |
Location | 333 Revolutionary Trl, Fairfax, South Carolina |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1851656243 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 261 (South Carolina) | Primary |
Provider Name | Low Country Health Care System Inc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1053475566 PECOS PAC ID: 4284530940 Enrollment ID: O20031211000944 |
Provider Name | Low Country Health Care System Inc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1578659942 PECOS PAC ID: 4284530940 Enrollment ID: O20160524000583 |
Provider Name | Low Country Health Care System Inc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1235225608 PECOS PAC ID: 4284530940 Enrollment ID: O20160606001593 |
Provider Name | Low Country Health Care System Inc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1821518556 PECOS PAC ID: 4284530940 Enrollment ID: O20181220002947 |
Provider Name | Low Country Health Care System Inc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1780112912 PECOS PAC ID: 4284530940 Enrollment ID: O20190610001031 |
Provider Name | Low Country Health Care System Inc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1306378310 PECOS PAC ID: 4284530940 Enrollment ID: O20200107003426 |
Mailing Address | Practice Location Address |
---|---|
Wanda W Tutt, LRD 333 Revolutionary Trl, Fairfax, SC 29827-7109 Ph: (803) 632-2533 | Wanda W Tutt, LRD 333 Revolutionary Trl, Fairfax, SC 29827-7109 Ph: (803) 632-2533 |