Healthcare Provider Details

I. General information

NPI: 1144508144
Provider Name (Legal Business Name): ELIZABETH HUTCHINS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BROAD STREET PLZ BROAD STREET MEDICAL GROUP
GLENS FALLS NY
12801-4363
US

IV. Provider business mailing address

PO BOX 304
GLENS FALLS NY
12801-0304
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-1770
  • Fax: 518-926-1799
Mailing address:
  • Phone: 518-926-1770
  • Fax: 518-926-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: