Provider Demographics
NPI:1992236434
Name:HUTCHERSON, GWENDOLYN (STNA)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:HUTCHERSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W 73RD ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45216-1808
Mailing Address - Country:US
Mailing Address - Phone:513-612-0664
Mailing Address - Fax:
Practice Address - Street 1:14 W 73RD ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1808
Practice Address - Country:US
Practice Address - Phone:513-612-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3742556510942472B0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472B0301XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherBiomedical Engineering