Healthcare Provider Details

I. General information

NPI: 1912236837
Provider Name (Legal Business Name): SANDRA JEAN HUTSON RN MONTRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4937 CARIBEE DR
SAINT LOUIS MO
63128-2923
US

IV. Provider business mailing address

4937 CARIBEE DR
SAINT LOUIS MO
63128-2923
US

V. Phone/Fax

Practice location:
  • Phone: 314-954-1801
  • Fax:
Mailing address:
  • Phone: 314-954-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number099648
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: