Healthcare Provider Details

I. General information

NPI: 1679224653
Provider Name (Legal Business Name): REBECCA DEE HUTCHINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 3 MILE RD NW STE 100
GRAND RAPIDS MI
49544-1624
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-9300
  • Fax:
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: