Healthcare Provider Details

I. General information

NPI: 1871069005
Provider Name (Legal Business Name): MARY P. HUTCHINGS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 JACKSON ROAD
LYONS NY
14489
US

IV. Provider business mailing address

7408 WALL STREET
WOLCOTT NY
14590
US

V. Phone/Fax

Practice location:
  • Phone: 315-481-5351
  • Fax:
Mailing address:
  • Phone: 315-481-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0149240
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: