Provider Demographics
NPI:1912236837
Name:HUTSON, SANDRA JEAN (RN MONTRICE)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:HUTSON
Suffix:
Gender:F
Credentials:RN MONTRICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 CARIBEE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2923
Mailing Address - Country:US
Mailing Address - Phone:314-954-1801
Mailing Address - Fax:
Practice Address - Street 1:4937 CARIBEE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2923
Practice Address - Country:US
Practice Address - Phone:314-954-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO099648374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-2014512OtherEMPLOYER IDENTIFICATION NUMBER