Healthcare Provider Details

I. General information

NPI: 1114222643
Provider Name (Legal Business Name): FAITH HUTCHINSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 JEFFERSON AVE
ROCKVILLE CENTRE NY
11570-3312
US

IV. Provider business mailing address

510 JEFFERSON AVE
ROCKVILLE CENTRE NY
11570-3312
US

V. Phone/Fax

Practice location:
  • Phone: 347-668-6078
  • Fax: 516-678-0728
Mailing address:
  • Phone: 347-668-6078
  • Fax: 516-678-0728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number211433-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number02906389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: