Healthcare Provider Details

I. General information

NPI: 1033507454
Provider Name (Legal Business Name): MISS KATHLEEN HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18316 MIDDLEBELT RD
LIVONIA MI
48152-5007
US

IV. Provider business mailing address

555 E WILLIAM ST APARTMENT 9A
ANN ARBOR MI
48104-2441
US

V. Phone/Fax

Practice location:
  • Phone: 248-615-9730
  • Fax:
Mailing address:
  • Phone: 704-277-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: