Healthcare Provider Details

I. General information

NPI: 1114068178
Provider Name (Legal Business Name): GAYLE L HUTZELL CDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4795 LINDA DR
GENEVA OH
44041-9750
US

IV. Provider business mailing address

4795 LINDA DR
GENEVA OH
44041-9750
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-2214
  • Fax: 440-466-2216
Mailing address:
  • Phone: 440-466-2214
  • Fax: 440-466-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: