Provider Demographics
NPI:1932239746
Name:HUTTO, MARY (RPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HUTTO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 NAELE RD
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8750
Mailing Address - Country:US
Mailing Address - Phone:808-878-6739
Mailing Address - Fax:
Practice Address - Street 1:333 NAELE RD
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8750
Practice Address - Country:US
Practice Address - Phone:808-878-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-801174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI055241-01Medicaid
HIB6363-2OtherHMSA
HIB6363-2OtherHMSA