Provider Demographics
NPI:1356163240
Name:HUTANU, MONICA EUGENIA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:EUGENIA
Last Name:HUTANU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 DARLENE LN APT 173
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1108
Mailing Address - Country:US
Mailing Address - Phone:810-908-7651
Mailing Address - Fax:
Practice Address - Street 1:1150 DARLENE LN APT 173
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1108
Practice Address - Country:US
Practice Address - Phone:810-908-7651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA222416363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant