Provider Demographics
NPI:1417192923
Name:HITCHKO, MARY CATHERINE (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:HITCHKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 GREENBANK DR
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9308
Mailing Address - Country:US
Mailing Address - Phone:808-268-4830
Mailing Address - Fax:
Practice Address - Street 1:1150 GREENBANK DR
Practice Address - Street 2:
Practice Address - City:BEN LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95005-9308
Practice Address - Country:US
Practice Address - Phone:808-268-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303651163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse