Healthcare Provider Details

I. General information

NPI: 1174542930
Provider Name (Legal Business Name): GARY MARK HUTSKO CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E END BLVD VA MEDICAL CENTER
WILKES BARRE PA
18711-0030
US

IV. Provider business mailing address

1087 LOYALVILLE OUTLET RD
HARVEYS LAKE PA
18618-2114
US

V. Phone/Fax

Practice location:
  • Phone: 570-824-3521
  • Fax:
Mailing address:
  • Phone: 570-477-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007081
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: