Healthcare Provider Details

I. General information

NPI: 1356300768
Provider Name (Legal Business Name): SONDRA KAY HUTCHISON CANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 LAFAYETTE RD STE 200
CRAWFORDSVILLE IN
47933-1092
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 765-359-2230
  • Fax: 765-359-2236
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number71001764A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001764A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: