Most Relevant Information
Provider Data
| NPI Number: | 1003211012 |
| Provider Name: | THERESA KAUTH |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 209.011910 |
Most Important Dates
| Enumeration Date: | 11/03/2014 |
| Last Updated: | 05/06/2015 |
Provider Practice Location
108 W MARKET ST
BLOOMINGTON
IL
617013918
Practice Location Phone/Fax
| Phone: | 3098275351 |
| Fax: | 3098296808 |
Provider Mailing Location
108 W MARKET ST
BLOOMINGTON
IL
617013918
Provider Mailing Phone/Fax
| Phone: | 3098275351 |
| Fax: | 3098296808 |