Healthcare Provider Details

I. General information

NPI: 1881379956
Provider Name (Legal Business Name): LATOYA HUTCHERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 STEWART AVE
CALUMET CITY IL
60409-2028
US

IV. Provider business mailing address

1106 STEWART AVE
CALUMET CITY IL
60409-2028
US

V. Phone/Fax

Practice location:
  • Phone: 708-278-1229
  • Fax:
Mailing address:
  • Phone: 708-278-1229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License NumberH32652081970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: