Provider Demographics
NPI:1952912206
Name:HAUTAJARVI, CORRIE (DNP)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:HAUTAJARVI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CORRIE
Other - Middle Name:
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2193
Mailing Address - Country:US
Mailing Address - Phone:218-249-7960
Mailing Address - Fax:
Practice Address - Street 1:1001 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2207
Practice Address - Country:US
Practice Address - Phone:218-249-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily