Healthcare Provider Details

I. General information

NPI: 1417742958
Provider Name (Legal Business Name): COURTNEY KAY HUTTUNEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PLEASANT AVE S
PARK RAPIDS MN
56470-1431
US

IV. Provider business mailing address

600 PLEASANT AVE S
PARK RAPIDS MN
56470-1431
US

V. Phone/Fax

Practice location:
  • Phone: 218-616-3055
  • Fax:
Mailing address:
  • Phone: 218-616-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5236
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: