Provider Demographics
NPI:1063912467
Name:HUTSON, DEBRA J
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:HUTSON
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 1:8935 E 2360 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:COLLISON
Mailing Address - State:IL
Mailing Address - Zip Code:61831-9737
Mailing Address - Country:US
Mailing Address - Phone:217-597-4842
Mailing Address - Fax:
Practice Address - Street 1:8935 E 2360 NORTH RD
Practice Address - Street 2:
Practice Address - City:COLLISON
Practice Address - State:IL
Practice Address - Zip Code:61831-9737
Practice Address - Country:US
Practice Address - Phone:217-597-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide