Healthcare Provider Details

I. General information

NPI: 1023233509
Provider Name (Legal Business Name): SALLY ALICE HUTTON RN,ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BENTON STREET
OMAK WA
98841
US

IV. Provider business mailing address

PO BOX 1192
TONASKET WA
98855-1192
US

V. Phone/Fax

Practice location:
  • Phone: 509-422-7455
  • Fax: 509-422-7457
Mailing address:
  • Phone: 509-422-7455
  • Fax: 509-422-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30002497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: