Provider Demographics
NPI:1336164870
Name:HUTTON, JAN M (FNP)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:M
Last Name:HUTTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 WINTER ST
Mailing Address - Street 2:4TH FL
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1424
Mailing Address - Country:US
Mailing Address - Phone:781-419-8354
Mailing Address - Fax:
Practice Address - Street 1:950 WINTER ST
Practice Address - Street 2:4TH FL
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1424
Practice Address - Country:US
Practice Address - Phone:781-419-8354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily