Healthcare Provider Details

I. General information

NPI: 1699955518
Provider Name (Legal Business Name): KATHERINE ELIZABETH HUTCHISON-ULLOA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 01/25/2022
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 COLUMBUS CIR #203
ATHENS OH
45701-1371
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 740-249-4122
  • Fax: 740-249-4126
Mailing address:
  • Phone: 614-544-6155
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-009449
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: