Healthcare Provider Details

I. General information

NPI: 1205166535
Provider Name (Legal Business Name): RENEE LYNN JOHNSON KOTLARZ CNP, PHN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MAIN ST N STE 201B
HUTCHINSON MN
55350-1819
US

IV. Provider business mailing address

114 MAIN ST N STE 201B
HUTCHINSON MN
55350-1819
US

V. Phone/Fax

Practice location:
  • Phone: 320-752-0778
  • Fax: 320-753-0779
Mailing address:
  • Phone: 320-752-0778
  • Fax: 320-753-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR1378197
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9763
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: