MEDICARE: MRS. MARY D HUTTO R.N.

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	163W00000X	Registered Nurse	RN.18592	SC

General Provider Information

NPI Number	:	1174968192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY D HUTTO R.N.

Provider Business Mailing Address
First Line	:	2670 BONDS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-7529
Country	:	US
Telephone Number	:	843-746-7428
Fax Number	:	843-746-7438

Provider Business Practice Location Address
First Line	:	2670 BONDS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-7529
Country	:	US
Telephone Number	:	843-746-7428
Fax Number	:	843-746-7438

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

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/03/2013

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