Healthcare Provider Details

I. General information

NPI: 1063059145
Provider Name (Legal Business Name): LATOYA LANNETTE HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2019
Last Update Date: 12/08/2019
Certification Date: 12/08/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 OAK LN
EWING NJ
08618-4002
US

IV. Provider business mailing address

72 WHITEBIRCH CT
LUMBERTON NJ
08048-3426
US

V. Phone/Fax

Practice location:
  • Phone: 609-556-5487
  • Fax:
Mailing address:
  • Phone: 609-556-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP07088500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: