MEDICARE: PAUL JUTTE PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	026687	OH

General Provider Information

NPI Number	:	1114540317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL JUTTE PMHNP-BC

Provider Business Mailing Address
First Line	:	9049 SPRINGBORO PIKE STE A
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-5057
Country	:	US
Telephone Number	:	937-759-0545
Fax Number	:

Provider Business Practice Location Address
First Line	:	9049 SPRINGBORO PIKE STE A
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-5057
Country	:	US
Telephone Number	:	937-759-0545
Fax Number	:	937-759-0549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	08/23/2023

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