Provider Demographics
NPI:1710531066
Name:UTZ, TOBI ANN (LAC, MACM)
Entity Type:Individual
Prefix:
First Name:TOBI
Middle Name:ANN
Last Name:UTZ
Suffix:
Gender:F
Credentials:LAC, MACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-4511
Mailing Address - Country:US
Mailing Address - Phone:507-318-0335
Mailing Address - Fax:
Practice Address - Street 1:916 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-4511
Practice Address - Country:US
Practice Address - Phone:507-318-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018007666171100000X
MN1867171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist