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General NPI Number Information
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NPI Number | 1013192046
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Entity Type | Individual
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Provider Name | CARLA R. NUTTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 10 MARTIN AVE STE 225
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City | NAPERVILLE
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State | IL
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Zip | 60540-6590
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Country | US
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Telephone | 303-355-5633
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Fax | 630-355-5215
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Provider Business Mailing Address
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Address Line | 10 MARTIN AVE STE 225
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City | NAPERVILLE
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State | IL
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Zip | 60540-6590
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Country | US
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Telephone | 630-355-5633
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Fax | 630-355-5215
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 00777
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.006881
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License Number State | IL
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