Provider Demographics
NPI:1114222643
Name:HUTCHINSON, FAITH (LPN)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3312
Mailing Address - Country:US
Mailing Address - Phone:347-668-6078
Mailing Address - Fax:516-678-0728
Practice Address - Street 1:510 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3312
Practice Address - Country:US
Practice Address - Phone:347-668-6078
Practice Address - Fax:516-678-0728
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211433-1164W00000X
NY02906389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02906389Medicaid