Healthcare Provider Details

I. General information

NPI: 1659462208
Provider Name (Legal Business Name): ELIZABETH A HUTSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 PULLMAN DR
SPARKS NV
89434-7921
US

IV. Provider business mailing address

1441 PULLMAN DR
SPARKS NV
89434-7921
US

V. Phone/Fax

Practice location:
  • Phone: 775-432-1343
  • Fax: 775-324-0858
Mailing address:
  • Phone: 775-432-1343
  • Fax: 775-324-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number9829
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number9829
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: