Provider Demographics
NPI:1134998370
Name:UTLEY, MONIQUE RENEE
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:RENEE
Last Name:UTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N CEDAR AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2306
Mailing Address - Country:US
Mailing Address - Phone:612-404-0561
Mailing Address - Fax:
Practice Address - Street 1:202 N CEDAR AVE STE 1
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2306
Practice Address - Country:US
Practice Address - Phone:612-404-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health