Provider Demographics
NPI:1497761332
Name:HUTCHISON, SANDRA-LYNN FRANCES (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA-LYNN
Middle Name:FRANCES
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SANDRA-LYNN
Other - Middle Name:FRANCES
Other - Last Name:PIETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:830 AINSWORTH DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1630
Practice Address - Country:US
Practice Address - Phone:928-777-5800
Practice Address - Fax:928-776-0405
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ120430Medicaid
AZ120430Medicaid
AZP67213Medicare UPIN