Provider Demographics
NPI:1245022607
Name:HUTCHISON, MICA (CHA)
Entity type:Individual
Prefix:
First Name:MICA
Middle Name:
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:CHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 60 BOX 299K
Mailing Address - Street 2:
Mailing Address - City:COPPER CENTER
Mailing Address - State:AK
Mailing Address - Zip Code:99573-9704
Mailing Address - Country:US
Mailing Address - Phone:907-259-3214
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 52
Practice Address - Street 2:
Practice Address - City:CHITINA
Practice Address - State:AK
Practice Address - Zip Code:99566-0052
Practice Address - Country:US
Practice Address - Phone:907-823-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK23-1706-II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker