Healthcare Provider Details

I. General information

NPI: 1336164870
Provider Name (Legal Business Name): JAN M HUTTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 WINTER ST 4TH FL
WALTHAM MA
02451-1424
US

IV. Provider business mailing address

950 WINTER ST 4TH FL
WALTHAM MA
02451-1424
US

V. Phone/Fax

Practice location:
  • Phone: 781-419-8354
  • Fax:
Mailing address:
  • Phone: 781-419-8354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number232454
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: