Provider Demographics
NPI:1285836254
Name:JUTTE, CAROL G (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:G
Last Name:JUTTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 SAINT PETER RD
Mailing Address - Street 2:
Mailing Address - City:FORT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-9704
Mailing Address - Country:US
Mailing Address - Phone:419-375-2609
Mailing Address - Fax:
Practice Address - Street 1:1795 SAINT PETER RD
Practice Address - Street 2:
Practice Address - City:FORT RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846-9704
Practice Address - Country:US
Practice Address - Phone:419-375-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 302332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2560714Medicaid