Healthcare Provider Details

I. General information

NPI: 1114540317
Provider Name (Legal Business Name): PAUL JUTTE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9049 SPRINGBORO PIKE STE A
MIAMISBURG OH
45342-5057
US

IV. Provider business mailing address

9049 SPRINGBORO PIKE STE A
MIAMISBURG OH
45342-5057
US

V. Phone/Fax

Practice location:
  • Phone: 937-759-0545
  • Fax: 937-759-0549
Mailing address:
  • Phone: 937-759-0545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number026687
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: