Provider Demographics
NPI:1013990985
Name:HUTTO, OLIN BRADFORD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:OLIN
Middle Name:BRADFORD
Last Name:HUTTO
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 1:1789 OLD 96 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:BATESBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29006-9618
Mailing Address - Country:US
Mailing Address - Phone:803-443-3807
Mailing Address - Fax:
Practice Address - Street 1:1789 OLD 96 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:BATESBURG
Practice Address - State:SC
Practice Address - Zip Code:29006-9618
Practice Address - Country:US
Practice Address - Phone:803-443-3807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1166367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1022Medicaid
SCAN1022Medicaid