Individual
HEIDI KATHLEEN HYNES NUTTALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 KENNEDY DR, STE 100, BRADLEY, IL 60915
(815) 928-8050
Mailing address
400 KENNEDY DR, STE 100, BRADLEY, IL 60915
(815) 928-8050
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085003195
IL
Other
Enumeration date
03/27/2008
Last updated
08/30/2011
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