Provider Demographics
NPI:1174883391
Name:HUTCHINS, STACY M (RN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:HUTCHINS
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 1:2 LODGEPOLE DR
Mailing Address - Street 2:
Mailing Address - City:DUBOIS
Mailing Address - State:WY
Mailing Address - Zip Code:82513-9619
Mailing Address - Country:US
Mailing Address - Phone:307-455-3388
Mailing Address - Fax:307-332-0131
Practice Address - Street 1:2 LODGEPOLE DR
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:WY
Practice Address - Zip Code:82513-9619
Practice Address - Country:US
Practice Address - Phone:307-455-3388
Practice Address - Fax:307-332-0131
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22680163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY105726000Medicaid