Healthcare Provider Details

I. General information

NPI: 1932924057
Provider Name (Legal Business Name): KRISTEL HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 VICTORY PARK DR
LINCOLN NE
68510-2484
US

IV. Provider business mailing address

120 WEDGEWOOD DR
LINCOLN NE
68510-2431
US

V. Phone/Fax

Practice location:
  • Phone: 531-220-2493
  • Fax:
Mailing address:
  • Phone: 402-441-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPSS-319
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: