Healthcare Provider Details

I. General information

NPI: 1689134553
Provider Name (Legal Business Name): DANA HUTCHISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 DURAND AVE
MOUNT PLEASANT WI
53406-4956
US

IV. Provider business mailing address

8345 OLD SPRING ST
MOUNT PLEASANT WI
53406-3147
US

V. Phone/Fax

Practice location:
  • Phone: 262-204-7542
  • Fax:
Mailing address:
  • Phone: 262-930-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9151-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: