Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 604642 | TX |
NPI | 1003879651 |
---|---|
Provider Name | Mrs. Lori Elaine Hutson |
First Address | Richardson, TX 75082-3552 |
Second Address | Dallas, TX 75246-2096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 13/07/2007 |