Provider Demographics
NPI:1417136532
Name:HUTELMYER, CAROL (MSN CRNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HUTELMYER
Suffix:
Gender:F
Credentials:MSN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:COMMUNITY PRACTICE CENTER, PALEY 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-7991
Mailing Address - Fax:215-456-7375
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:COMMUNITY PRACTICE CENTER, PALEY 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-7991
Practice Address - Fax:215-456-7375
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP001859C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health