Individual
JULIE A DESUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
200 E PENNSYLVANIA AVE, SUITE 212, PEORIA, IL 61603-3089
(309) 676-8123
(309) 676-8455
Mailing address
200 E PENNSYLVANIA AVE, SUITE 212, PEORIA, IL 61603-3089
(309) 676-8123
(309) 676-8455
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085001405
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00016083
RAILROAD MEDICARE
IL
Enumeration date
03/09/2007
Last updated
12/11/2008
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