Provider Demographics
NPI:1023233509
Name:HUTTON, SALLY ALICE (RN,ARNP)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ALICE
Last Name:HUTTON
Suffix:
Gender:F
Credentials:RN,ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1192
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-1192
Mailing Address - Country:US
Mailing Address - Phone:509-422-7455
Mailing Address - Fax:509-422-7457
Practice Address - Street 1:617 BENTON STREET
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841
Practice Address - Country:US
Practice Address - Phone:509-422-7455
Practice Address - Fax:509-422-7457
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002497363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology