Healthcare Provider Details

I. General information

NPI: 1972732725
Provider Name (Legal Business Name): MRS. MARY LORRAINE HUTCHISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 BROADWAY STE A-J
MERRILLVILLE IN
46410-2665
US

IV. Provider business mailing address

PO BOX 1014
CROWN POINT IN
46308
US

V. Phone/Fax

Practice location:
  • Phone: 219-884-9180
  • Fax:
Mailing address:
  • Phone: 219-552-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28092325A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: