Provider Demographics
NPI:1508607946
Name:HUTSON, STEFANIE JEAN (MSN, RN)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:JEAN
Last Name:HUTSON
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:JEAN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:454 W LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2954
Mailing Address - Country:US
Mailing Address - Phone:336-789-9492
Mailing Address - Fax:
Practice Address - Street 1:454 W LEBANON ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2954
Practice Address - Country:US
Practice Address - Phone:336-789-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210152163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health