Healthcare Provider Details

I. General information

NPI: 1336771427
Provider Name (Legal Business Name): WANDA R HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MERTON RD APT 308
DETROIT MI
48203-2292
US

IV. Provider business mailing address

275 MERTON RD APT 308
DETROIT MI
48203-2292
US

V. Phone/Fax

Practice location:
  • Phone: 313-896-8514
  • Fax:
Mailing address:
  • Phone: 313-896-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number83-2648701
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: