Healthcare Provider Details

I. General information

NPI: 1992076814
Provider Name (Legal Business Name): KELLY LYNN HUTCHINSON N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 UNIVERSITY AVE
MIDDLETON WI
53562-2757
US

IV. Provider business mailing address

7111 UNIVERSITY AVE
MIDDLETON WI
53562-2757
US

V. Phone/Fax

Practice location:
  • Phone: 603-205-2311
  • Fax:
Mailing address:
  • Phone: 603-205-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1895
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: