Healthcare Provider Details

I. General information

NPI: 1134103278
Provider Name (Legal Business Name): KARA M HUTTON APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 WATER ST
EXCELSIOR MN
55331-3072
US

IV. Provider business mailing address

675 WATER ST
EXCELSIOR MN
55331-3072
US

V. Phone/Fax

Practice location:
  • Phone: 952-906-7855
  • Fax: 952-470-4523
Mailing address:
  • Phone: 952-906-7855
  • Fax: 952-470-4523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR122257-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: