Healthcare Provider Details

I. General information

NPI: 1417617416
Provider Name (Legal Business Name): MIGGIN MONTANAY HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2021
Last Update Date: 12/19/2021
Certification Date: 12/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S MAIN ST
SUMMITVILLE IN
46070-9745
US

IV. Provider business mailing address

416 S MAIN ST
SUMMITVILLE IN
46070-9745
US

V. Phone/Fax

Practice location:
  • Phone: 765-506-9977
  • Fax:
Mailing address:
  • Phone: 765-506-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: