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NPI Code Detail

MEDICARE: SUSAN RENEE TUTTLE APN

MEDICARE: SUSAN RENEE TUTTLE APN
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
1363LA2200XAdult Health Nurse Practitioner209003723IL
2363L00000XNurse Practitioner209.003723IL

General Provider Information

NPI Number : 1740286988
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN RENEE TUTTLE APN
Provider Business Mailing Address
First Line : 325 SPRING ST
Second Line :
City : RED BUD
State : IL
Zip : 62278-1105
Country : US
Telephone Number : 618-282-7373
Fax Number :
Provider Business Practice Location Address
First Line : 325 SPRING ST
Second Line :
City : RED BUD
State : IL
Zip : 62278-1105
Country : US
Telephone Number : 618-282-7373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 12/29/2022

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Directions to “ SUSAN RENEE TUTTLE APN” Practice Location

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