Healthcare Provider Details

I. General information

NPI: 1982364600
Provider Name (Legal Business Name): MICHELLE HUTT AP6123863
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 WESTLAKE AVE N STE 105
SEATTLE WA
98109-6241
US

IV. Provider business mailing address

14321 20TH AVENUE CT S
SPANAWAY WA
98387-9013
US

V. Phone/Fax

Practice location:
  • Phone: 253-561-1789
  • Fax:
Mailing address:
  • Phone: 253-316-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP6123863
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: