Provider Demographics
NPI:1922008168
Name:HUTCHINSON, BRADLEY (CRNA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 5 BOX 20
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-9611
Mailing Address - Country:US
Mailing Address - Phone:276-935-1129
Mailing Address - Fax:276-935-1538
Practice Address - Street 1:RR 5 BOX 20
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-9611
Practice Address - Country:US
Practice Address - Phone:276-935-1129
Practice Address - Fax:276-935-1538
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001147269367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2602581000OtherWV MCAD
VA8939438Medicaid
WV001717382OtherMTN STATE BCBS
VA430068748Medicare ID - Type Unspecified
VA8939438Medicaid
VAW42910Medicare UPIN