1376053579 NPI number — SHELBY ALYSSA HUTCHINS MBA, AT, ATC

Table of content: SHELBY ALYSSA HUTCHINS MBA, AT, ATC (NPI 1376053579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376053579 NPI number — SHELBY ALYSSA HUTCHINS MBA, AT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTCHINS
Provider First Name:
SHELBY
Provider Middle Name:
ALYSSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBA, AT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376053579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1139 DIVISION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADRIAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49221-4214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6518 SAND CREEK HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAND CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49279-9703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-731-6045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2601002267 . This is a "STATE LICENSURE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2000023721 . This is a "BOC" identifier . This identifiers is of the category "OTHER".




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