Provider Demographics
NPI:1154702470
Name:HUTTO, ELAINE (RN)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:HUTTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 CHINABERRY CT
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9637
Mailing Address - Country:US
Mailing Address - Phone:706-244-9841
Mailing Address - Fax:
Practice Address - Street 1:767 CHINABERRY CT
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9637
Practice Address - Country:US
Practice Address - Phone:706-244-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 107289163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse