Individual
JODY K GURTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 W. CURTIS ROAD, PEDIATRICS, CHAMPAIGN, IL 61822
(217) 365-6202
(217) 326-1234
Mailing address
PO BOX 6004, URBANA, IL 61803-6004
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
209004436
IL
363L00000X
Nurse Practitioner
Primary
209004436
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041206785
—
IL
01
—
IL2613
MEDICARE GROUP PTAN
IL
Enumeration date
08/09/2007
Last updated
06/11/2012
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