Healthcare Provider Details

I. General information

NPI: 1689394181
Provider Name (Legal Business Name): EMILEE HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 W FIREWEED LN STE 160
ANCHORAGE AK
99503-2561
US

IV. Provider business mailing address

402 S EMERSON AVE
GILLETTE WY
82716-3839
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-0862
  • Fax:
Mailing address:
  • Phone: 307-763-1698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197915
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: