Healthcare Provider Details

I. General information

NPI: 1730735747
Provider Name (Legal Business Name): ELIZABETH LACOLE HUTCHINSON MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E WESTERN RESERVE RD
POLAND OH
44514-3359
US

IV. Provider business mailing address

800 E WESTERN RESERVE RD
POLAND OH
44514-3359
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-4833
  • Fax: 330-726-1123
Mailing address:
  • Phone: 330-726-4833
  • Fax: 330-726-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025474
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: