Provider Demographics
NPI:1881188779
Name:HUTTO, SHANA DANIELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:DANIELLE
Last Name:HUTTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HILLSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-4646
Mailing Address - Country:US
Mailing Address - Phone:912-245-1577
Mailing Address - Fax:
Practice Address - Street 1:454 VERNON WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-7887
Practice Address - Country:US
Practice Address - Phone:912-750-8801
Practice Address - Fax:912-705-8851
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170590363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care