Healthcare Provider Details

I. General information

NPI: 1659869121
Provider Name (Legal Business Name): SHANNA MARIE HUTCHESON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 LAMAR AVE
OVERLAND PARK KS
66211-1508
US

IV. Provider business mailing address

15924 W 124TH CIR
OLATHE KS
66062-4322
US

V. Phone/Fax

Practice location:
  • Phone: 913-221-6256
  • Fax:
Mailing address:
  • Phone: 913-221-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: