Healthcare Provider Details

I. General information

NPI: 1053615864
Provider Name (Legal Business Name): MISS TRINIS HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2011
Last Update Date: 01/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9953 LEWIS AND CLARK BLVD SUITE 208
SAINT LOUIS MO
63136-5336
US

IV. Provider business mailing address

9953 LEWIS AND CLARK BLVD SUITE 208
SAINT LOUIS MO
63136-5336
US

V. Phone/Fax

Practice location:
  • Phone: 314-921-5672
  • Fax: 314-867-6473
Mailing address:
  • Phone: 314-921-5672
  • Fax: 314-867-6473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: