=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013727775
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ANNA LYNN HUTTENGA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1109 KENOWA AVE SW
-----------------------------------------------------
City | BYRON CENTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49315-6979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-929-6717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1109 KENOWA AVE SW
-----------------------------------------------------
City | BYRON CENTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49315-6979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-929-6717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------