JULIE A DESUTTER (NPI# 1093847600) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093847600 |
| Entity Type | Individual |
| Full Name | JULIE A DESUTTER |
| Credential | PA |
| Practice Address |
200 E Pennsylvania Ave Suite 212 Peoria IL 61603-3089 |
| Practice Telephone | 3096768123 |
| Practice Fax Number | 3096768455 |
| Mailing Telephone | 3096768123 |
| Mailing Fax Number | 3096768455 |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2008-12-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
085001405 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RAILROAD MEDICARE | P00016083 | 01 |
| Street Address |
200 E PENNSYLVANIA AVE SUITE 212 |
| City | PEORIA |
| State | IL |
| Zip Code | 61603-3089 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912901711 | James W Bauer | Internal Medicine | 200 E Pennsylvania Ave, Ste 105, Peoria, IL 61603-3045 | 2005-06-09 |
| 1205473154 | Gargi Dnyanesh Gupte | Physician Assistant | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2019-12-10 |
| 1487127734 | Stephanie S Beckstrom | Nurse Practitioner | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2019-01-09 |
| 1174093009 | Katelyn M Johnson | Nurse Practitioner | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2018-12-04 |
| 1093298127 | Loan T Nguyen | Nurse Practitioner | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2018-09-14 |
| 1922580695 | Anna K Boyce | Audiologist | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2018-08-30 |
| 1033604855 | Caroline Marie Boczar | Audiologist | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2018-06-25 |
| 1831608991 | Laurel K Donaldson | Audiologist | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2017-09-21 |
| 1851818835 | Cynthia I Guede | Nurse Practitioner | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2017-08-29 |
| 1275986051 | Travis E. Towne | Social Worker | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2016-07-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
| 1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
| 1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
| 1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
| 1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
| 1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
| Find all providers in zip 61603 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194343897 | Alyssa Kay Poland | Physician Assistant | 10006 W Los Gatos Dr, Peoria, AZ 85383-3343 | 2020-07-08 |
| 1871155143 | Terry Craven Wood | Physician Assistant | 7645 W Donald Dr, Peoria, AZ 85383-3142 | 2019-07-08 |
| 1174956031 | Kindal Alysse Sweet | Physician Assistant | 7677 W Paradise Ln Apt 1128, Peoria, AZ 85382-4974 | 2013-08-14 |
| 1831246669 | Joseph B Earl | Physician Assistant | 7615 W Thunderbird Rd Ste 105, Peoria, AZ 85381-6083 | 2007-01-04 |
| 1275612681 | James Anthony Caruso | Physician Assistant | 9601 North Lindbergh Dr, # 230, Peoria, IL 61615 | 2006-11-04 |
| 1922103407 | Brady Paul Nelson | Physician Assistant | 13943 N . 91st Ave Building I, Peoria, AZ 85381-3692 | 2006-09-13 |
| 1689786444 | Bruce A Ropte | Physician Assistant | 21731 N. 77th Avenue, Peoria, AZ 85382 | 2006-08-31 |
| 1265543391 | Elizabeth D Moore | Physician Assistant | 8940 N Wood Sage Road, Peoria, IL 61615 | 2006-08-31 |
| 1174500581 | Janis Suzann Forch | Physician Assistant | 7615 W Thunderbird Rd, Ste 106, Peoria, AZ 85381-6083 | 2005-12-28 |
| 1508858754 | Kenneth B Caton | Physician Assistant | 9165 W Thunderbird Rd, Ste 100, Peoria, AZ 85381 | 2005-08-15 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.