Healthcare Provider Details

I. General information

NPI: 1194168401
Provider Name (Legal Business Name): MARY JO HUTCHINSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 SW G ST
GRANTS PASS OR
97526-2544
US

IV. Provider business mailing address

1215 SW G ST
GRANTS PASS OR
97526-2544
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-2373
  • Fax: 541-476-1526
Mailing address:
  • Phone: 541-476-2373
  • Fax: 541-476-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number088000251RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: