Healthcare Provider Details

I. General information

NPI: 1366883340
Provider Name (Legal Business Name): TAWNYA HUTCHISON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 WHITE ROCK LN
LEXINGTON SC
29072-7158
US

IV. Provider business mailing address

160 WHITE ROCK LN
LEXINGTON SC
29072-7158
US

V. Phone/Fax

Practice location:
  • Phone: 803-317-1390
  • Fax:
Mailing address:
  • Phone: 803-317-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number136
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: