Healthcare Provider Details

I. General information

NPI: 1396159562
Provider Name (Legal Business Name): PATRICIA LEE GUTHMILLER RN, CWON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 OAK ST
GRAND FORKS ND
58201-4460
US

IV. Provider business mailing address

5011 6TH AVE N
GRAND FORKS ND
58203-2609
US

V. Phone/Fax

Practice location:
  • Phone: 701-701-3304
  • Fax:
Mailing address:
  • Phone: 701-775-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR14525
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR188501-7
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberR188501-7
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberR14525
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: