Provider Demographics
NPI:1447503487
Name:CARNITHAN, JORI RETTERER (FNP, MSN)
Entity type:Individual
Prefix:
First Name:JORI
Middle Name:RETTERER
Last Name:CARNITHAN
Suffix:
Gender:F
Credentials:FNP, MSN
Other - Prefix:
Other - First Name:JORI
Other - Middle Name:ANNE
Other - Last Name:RETTERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1949 S BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9851
Mailing Address - Country:US
Mailing Address - Phone:331-259-4994
Mailing Address - Fax:630-385-2934
Practice Address - Street 1:1949 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9851
Practice Address - Country:US
Practice Address - Phone:331-259-4994
Practice Address - Fax:630-385-2934
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL377.001687363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily