Healthcare Provider Details

I. General information

NPI: 1790511616
Provider Name (Legal Business Name): ANDREA L. HUTCHISON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/24/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CURTIS RD
CHAMPAIGN IL
61822-9678
US

IV. Provider business mailing address

611 W PARK ST FAPC
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-365-6201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.030353
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: