Healthcare Provider Details

I. General information

NPI: 1205376670
Provider Name (Legal Business Name): OLIVIA HUTCHINSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 03/10/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 E. EDISON AVE
SUNNYSIDE WA
98944
US

IV. Provider business mailing address

PO BOX 719
SUNNYSIDE WA
98944-0719
US

V. Phone/Fax

Practice location:
  • Phone: 509-837-1587
  • Fax:
Mailing address:
  • Phone: 509-837-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86018472
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI61255036
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: