Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 125.064891 | IL |
NPI | 1205241221 |
---|---|
Provider Name | Lauren Hutchinson |
First Address | Gastonia, NC 28054-7488 |
Second Address | Springfield, IL 62702-6700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2014 |
Last Update Date | 31/03/2021 |