Provider Demographics
NPI:1548043144
Name:UTECHT, SHANNON ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:UTECHT
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 CLEARWATER RD # 201
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8463
Mailing Address - Country:US
Mailing Address - Phone:218-270-5590
Mailing Address - Fax:
Practice Address - Street 1:50 CENTRACARE DR
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-2100
Practice Address - Country:US
Practice Address - Phone:320-732-2131
Practice Address - Fax:320-732-6913
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2457064163WH0200X
390200000X
MN10893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program