MEDICARE: DEBRA J HUTSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1063912467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA J HUTSON

Provider Business Mailing Address
First Line	:	8935 E 2360 NORTH RD
Second Line	:
City	:	COLLISON
State	:	IL
Zip	:	61831-9737
Country	:	US
Telephone Number	:	217-597-4842
Fax Number	:

Provider Business Practice Location Address
First Line	:	8935 E 2360 NORTH RD
Second Line	:
City	:	COLLISON
State	:	IL
Zip	:	61831-9737
Country	:	US
Telephone Number	:	217-597-4842
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	02/13/2018

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