Healthcare Provider Details

I. General information

NPI: 1396763736
Provider Name (Legal Business Name): BEVERLY CRANDELL HUTCHINSON APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEVERLY CRANDELL-HUTCHINSON FNP, BC

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E H ST
IRON MOUNTAIN MI
49801
US

IV. Provider business mailing address

325 E H ST
IRON MOUNTAIN MI
49801-4760
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-3300
  • Fax:
Mailing address:
  • Phone: 906-774-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704142802
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704142802
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4704142802
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2005010462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: