Desutter, Julie A

Desutter, Julie A is an individual health care provider with primary practice located at 200 E Pennsylvania Ave Suite 212, Peoria IL 61603-3089. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Desutter, Julie A can be contacted via phone (309) 676-8123.

Contact Information

Primary practice address
200 E Pennsylvania Ave Suite 212 Peoria IL 61603-3089
Phone: (309) 676-8123
Fax: (309) 676-8455
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 085001405 Illinois

Profile Details

NPI number 1093847600
LBN Legal business name Desutter, Julie A
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 9th, 2007
Last updated Dec 11th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093847600 NPPES
Illinois Other P00016083 RAILROAD MEDICARE

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