Provider Demographics
NPI:1639126899
Name:HUTCHINS, JOANNA MARIE (PAC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIE
Last Name:HUTCHINS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1507
Mailing Address - Country:US
Mailing Address - Phone:608-231-3410
Mailing Address - Fax:608-231-3430
Practice Address - Street 1:2 SCIENCE COURT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711
Practice Address - Country:US
Practice Address - Phone:608-231-3410
Practice Address - Fax:608-231-3430
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1820-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41997500Medicaid
WI555659OtherDEAN HEALTH
200034118OtherRAILROAD MEDICARE
WI2005875OtherPHYSICIANS PLUS INSURANCE
WI555659OtherDEAN HEALTH