Provider Demographics
NPI:1831620731
Name:HUTCHINS, ELAINE (CNA)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:HUTCHINS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W HARTFORD AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1547
Mailing Address - Country:US
Mailing Address - Phone:580-382-1534
Mailing Address - Fax:
Practice Address - Street 1:205 W HARTFORD AVE STE 112
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1547
Practice Address - Country:US
Practice Address - Phone:580-382-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V631671115376K00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program