Healthcare Provider Details

I. General information

NPI: 1669895900
Provider Name (Legal Business Name): PAULA BRONWYN HUTCHISON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5704 ANO DR
LAS VEGAS NV
89131-2925
US

IV. Provider business mailing address

5704 ANO DR
LAS VEGAS NV
89131-2925
US

V. Phone/Fax

Practice location:
  • Phone: 702-658-0500
  • Fax:
Mailing address:
  • Phone: 702-658-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number11245
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number213264
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number213264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: