Healthcare Provider Details

I. General information

NPI: 1811210610
Provider Name (Legal Business Name): ROBERT EARL HUTCHINSON LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17029 118TH AVE
JAMAICA NY
11434-2215
US

IV. Provider business mailing address

170-29 118TH AVE
QUEENS NY
11434-2215
US

V. Phone/Fax

Practice location:
  • Phone: 347-753-7582
  • Fax:
Mailing address:
  • Phone: 347-753-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number299714-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299714-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: