Healthcare Provider Details

I. General information

NPI: 1154979680
Provider Name (Legal Business Name): ANGELA NICOLE HUTCHINSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA NICOLE HUTCHINSON FNP

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 GRAPEFIELD RD
BASTIAN VA
24314-4547
US

IV. Provider business mailing address

12301 GRAPEFIELD RD
BASTIAN VA
24314-4547
US

V. Phone/Fax

Practice location:
  • Phone: 276-688-2626
  • Fax: 276-688-4336
Mailing address:
  • Phone: 276-688-2626
  • Fax: 276-688-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178078
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: