Healthcare Provider Details

I. General information

NPI: 1508909409
Provider Name (Legal Business Name): SHIRLEY HUTCHINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 CRANE RD
WAXHAW NC
28173-8555
US

IV. Provider business mailing address

1316 CRANE RD
WAXHAW NC
28173-8555
US

V. Phone/Fax

Practice location:
  • Phone: 980-328-3770
  • Fax:
Mailing address:
  • Phone: 704-243-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200639
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: