Basic Information
| Provider Information | |||||||||
| NPI: | 1194861625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUTCHENS | ||||||||
| FirstName: | CHANCE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 E ROBINSON ST | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730716610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053647900 | ||||||||
| FaxNumber: | 4053666214 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 E ROBINSON ST | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730716610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053647900 | ||||||||
| FaxNumber: | 4053666214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1582 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 200104660A | 05 | OK | MEDICAID |