Provider Demographics
NPI:1396159562
Name:GUTHMILLER, PATRICIA LEE (RN, CWON)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LEE
Last Name:GUTHMILLER
Suffix:
Gender:F
Credentials:RN, CWON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2609
Mailing Address - Country:US
Mailing Address - Phone:701-775-5158
Mailing Address - Fax:
Practice Address - Street 1:718 OAK ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4460
Practice Address - Country:US
Practice Address - Phone:701-701-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR14525163W00000X, 163WE0900X
MNR188501-7163W00000X, 163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy