Healthcare Provider Details

I. General information

NPI: 1558922914
Provider Name (Legal Business Name): MARTINA KEMISHA HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 AVENUE N APT 1
BROOKLYN NY
11234-3612
US

IV. Provider business mailing address

4501 AVENUE N APT 1
BROOKLYN NY
11234-3612
US

V. Phone/Fax

Practice location:
  • Phone: 347-841-4866
  • Fax:
Mailing address:
  • Phone: 347-841-4866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7304411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: