Provider Demographics
NPI:1194980664
Name:KUTILEK, ROSE A (FNP-BC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:A
Last Name:KUTILEK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 N RUTLEDGE ST
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6700
Mailing Address - Country:US
Mailing Address - Phone:217-525-2500
Mailing Address - Fax:217-525-9374
Practice Address - Street 1:747 N RUTLEDGE ST
Practice Address - Street 2:SUITE 2204
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6700
Practice Address - Country:US
Practice Address - Phone:217-525-2500
Practice Address - Fax:217-525-9374
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily