Healthcare Provider Details

I. General information

NPI: 1093871220
Provider Name (Legal Business Name): THERESA L. HUTZLER APRN, AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA L. CORBIN

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BELLINGER ST
EAU CLAIRE WI
54703-5222
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0002
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-5222
  • Fax:
Mailing address:
  • Phone: 715-838-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number146779-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number146779-030
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number6128-33
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6128
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: