Healthcare Provider Details

I. General information

NPI: 1477515526
Provider Name (Legal Business Name): DAVID MICHARL HUTCHASON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 BEACH DRIVE EAST
RETSIL WA
98378
US

IV. Provider business mailing address

1141 BEACH DRIVE EAST
RETSIL WA
98378
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-4710
  • Fax:
Mailing address:
  • Phone: 360-895-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30004263
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: