Healthcare Provider Details

I. General information

NPI: 1609501345
Provider Name (Legal Business Name): JESSICA HUTCHINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19005 W CAPITOL DR STE 130
BROOKFIELD WI
53045-2705
US

IV. Provider business mailing address

2416 S 52ND ST
WEST ALLIS WI
53219-2384
US

V. Phone/Fax

Practice location:
  • Phone: 262-510-7462
  • Fax:
Mailing address:
  • Phone: 262-510-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112093-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: