Individual
JODI NUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
112 NE CRESCENT AVE, PEORIA, IL 61606-1901
(309) 672-4670
Mailing address
112 NE CRESCENT AVE, PEORIA, IL 61606-1901
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016028
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209016028
LICENSE APN
IL
Enumeration date
06/02/2017
Last updated
06/02/2017
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