Healthcare Provider Details

I. General information

NPI: 1821067620
Provider Name (Legal Business Name): WANDA G COLEMAN-HUTCHINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE KINGS COUNTY HOSPITAL CENTER
BROOKLYN NY
11203
US

IV. Provider business mailing address

255 DORSET ST
BROOKLYN NY
11236-1411
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-3500
  • Fax:
Mailing address:
  • Phone: 718-629-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number302906
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: