Provider Demographics
NPI:1841681970
Name:HUTCHINSON, CHALSEA
Entity type:Individual
Prefix:
First Name:CHALSEA
Middle Name:
Last Name:HUTCHINSON
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 1:1809 IVY OAK SQ
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4727
Mailing Address - Country:US
Mailing Address - Phone:703-434-3654
Mailing Address - Fax:571-223-6405
Practice Address - Street 1:1809 IVY OAK SQ
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4727
Practice Address - Country:US
Practice Address - Phone:703-434-3654
Practice Address - Fax:571-223-6405
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT-09000172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver