Provider Demographics
NPI:1114540317
Name:JUTTE, PAUL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:JUTTE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9049 SPRINGBORO PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5057
Mailing Address - Country:US
Mailing Address - Phone:937-759-0545
Mailing Address - Fax:
Practice Address - Street 1:9049 SPRINGBORO PIKE STE A
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-5057
Practice Address - Country:US
Practice Address - Phone:937-759-0545
Practice Address - Fax:937-759-0549
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH026687363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health