Healthcare Provider Details

I. General information

NPI: 1316119662
Provider Name (Legal Business Name): ELIZABETH A. HUTSON M.D. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
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 TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number9829
License Number StateNV

VIII. Authorized Official

Name: TINA FORSTER
Title or Position: BILLING SPECIALIST
Credential:
Phone: 775-800-1948