Provider Demographics
NPI:1205166535
Name:KOTLARZ, RENEE LYNN JOHNSON (CNP, PHN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN JOHNSON
Last Name:KOTLARZ
Suffix:
Gender:F
Credentials:CNP, PHN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MAIN ST N STE 201B
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-1819
Mailing Address - Country:US
Mailing Address - Phone:320-752-0778
Mailing Address - Fax:320-753-0779
Practice Address - Street 1:114 MAIN ST N STE 201B
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1819
Practice Address - Country:US
Practice Address - Phone:320-752-0778
Practice Address - Fax:320-753-0779
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1378197163WC1500X
MN9763363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health