Healthcare Provider Details

I. General information

NPI: 1568794246
Provider Name (Legal Business Name): EDITH HUTCHINSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 MADISON AVE APT 2B
NEW YORK NY
10037-2319
US

IV. Provider business mailing address

2171 MADISON AVE APT 2B
NEW YORK NY
10037-2319
US

V. Phone/Fax

Practice location:
  • Phone: 212-862-9234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number081568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: