Healthcare Provider Details

I. General information

NPI: 1720785298
Provider Name (Legal Business Name): MARIAH RENAE COUTURE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAH RENAE NIEMAN FNP

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49725 COUNTY ROAD 83
STAPLES MN
56479
US

IV. Provider business mailing address

49725 COUNTY 83
STAPLES MN
56479-5280
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-1515
  • Fax:
Mailing address:
  • Phone: 218-894-1515
  • Fax: 218-898-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9876
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: