Individual
MRS. CARLA MAE UTENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10129 TWP RD 8, OTTAWA, OH 45875
(419) 523-4231
Mailing address
12170 RD G-12, OTTAWA, OH 45875
(419) 876-3066
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN068301
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2526592
PROVIDER NUMBER
OH
Enumeration date
06/04/2007
Last updated
07/08/2007
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