Provider Demographics
NPI:1114059912
Name:HUTSON, STEVEN BRENT (LPN)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:BRENT
Last Name:HUTSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1073
Mailing Address - Country:US
Mailing Address - Phone:614-507-0852
Mailing Address - Fax:
Practice Address - Street 1:142 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1073
Practice Address - Country:US
Practice Address - Phone:614-507-0852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH115022164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2482666Medicaid