Provider Demographics
NPI:1982364600
Name:HUTT, MICHELLE (AP6123863)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HUTT
Suffix:
Gender:F
Credentials:AP6123863
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14321 20TH AVENUE CT S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-9013
Mailing Address - Country:US
Mailing Address - Phone:253-316-2224
Mailing Address - Fax:
Practice Address - Street 1:1633 WESTLAKE AVE N STE 105
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-6241
Practice Address - Country:US
Practice Address - Phone:253-561-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP6123863363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner