Healthcare Provider Details

I. General information

NPI: 1568704286
Provider Name (Legal Business Name): EMILY MARIA UTECH NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE NICU
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

8928 SAINT CROIX RD
WOODBURY MN
55125-3548
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6295
  • Fax:
Mailing address:
  • Phone: 651-307-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberUTE104376318
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: