Doctor Name: | TRICIA JEAN SHOUTZ |
NPI Number: | 1790199024 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | F0614082 |
Business Practice Address: | 20 9th St Se Long Prairie, MN - 563471404 |
Business Phone Number: | 3207322141 |
Business Fax Number: | |
Mailing Address: | 20 9th St Se, LONG PRAIRIE |
State: | MN |
Postal Code: | 563471404 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/14/2014 |
NPI Last Update Date: | 06/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | F0614082 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |