Provider Demographics
NPI:1396763736
Name:HUTCHINSON, BEVERLY CRANDELL (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:CRANDELL
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:CRANDELL-HUTCHINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, BC
Mailing Address - Street 1:325 E H ST
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4760
Mailing Address - Country:US
Mailing Address - Phone:906-774-3300
Mailing Address - Fax:
Practice Address - Street 1:325 E H ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801
Practice Address - Country:US
Practice Address - Phone:906-774-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704142802163W00000X, 363LF0000X, 164W00000X
MI2005010462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4845354Medicaid
MI300207909OtherTAX ID
MI300207909OtherTAX ID
MIQ67434Medicare UPIN
Q67434Medicare UPIN