Provider Demographics
NPI:1942295837
Name:HATCH, NELLYNN L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NELLYNN
Middle Name:L
Last Name:HATCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44344 DEQUINDRE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1040
Mailing Address - Country:US
Mailing Address - Phone:586-323-1500
Mailing Address - Fax:586-323-1515
Practice Address - Street 1:44344 DEQUINDRE RD STE 260
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1040
Practice Address - Country:US
Practice Address - Phone:586-323-1500
Practice Address - Fax:586-323-1515
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002238363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q49340Medicare UPIN
MIP28070062Medicare ID - Type Unspecified