Healthcare Provider Details

I. General information

NPI: 1760786032
Provider Name (Legal Business Name): MARISA LEA ZUTTER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA LEA FROST

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 3RD ST SW
PERHAM MN
56573-1137
US

IV. Provider business mailing address

43489 INLET ESTATES TRL
OTTERTAIL MN
56571-9471
US

V. Phone/Fax

Practice location:
  • Phone: 218-371-6117
  • Fax:
Mailing address:
  • Phone: 218-371-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR174289-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: