Provider Demographics
NPI:1891138327
Name:NKUTU, JIMMY N
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:N
Last Name:NKUTU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 HERON VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-8131
Mailing Address - Country:US
Mailing Address - Phone:847-812-0190
Mailing Address - Fax:847-886-7033
Practice Address - Street 1:1889 HERON VIEW WAY
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-8131
Practice Address - Country:US
Practice Address - Phone:847-812-0190
Practice Address - Fax:847-886-7033
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)