1447503487 NPI number — JORI RETTERER CARNITHAN FNP, MSN

Table of content: JORI RETTERER CARNITHAN FNP, MSN (NPI 1447503487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447503487 NPI number — JORI RETTERER CARNITHAN FNP, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARNITHAN
Provider First Name:
JORI
Provider Middle Name:
RETTERER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP, MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RETTERER
Provider Other First Name:
JORI
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447503487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1949 S BRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORKVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60560-9851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
331-259-4994
Provider Business Mailing Address Fax Number:
630-385-2934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1949 S BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORKVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60560-9851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
331-259-4994
Provider Business Practice Location Address Fax Number:
630-385-2934
Provider Enumeration Date:
10/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  377.001687 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 377.001687 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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