Individual
MRS. KIMBERLY JO DUTTLINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CRNA
Contact information
Practice address
925 WEST ST, PERU, IL 61354
(815) 223-3300
(815) 224-6763
Mailing address
925 WEST ST, PERU, IL 61354-2757
(815) 223-3300
(815) 224-6763
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209006987
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209006987
STATE LICENSE
IL
Enumeration date
02/22/2008
Last updated
05/18/2018
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