MEDICARE: ERICA D GUTSHALL WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	14132NP	OH
2	163W00000X	Registered Nurse	RN342596	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518204973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA D GUTSHALL WHNP

Provider Business Mailing Address
First Line	:	77 EAST MIDLOTHIAN BLVD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44507-2021
Country	:	US
Telephone Number	:	330-788-2487
Fax Number	:	330-788-8620

Provider Business Practice Location Address
First Line	:	77 EAST MIDLOTHIAN BLVD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44507-2021
Country	:	US
Telephone Number	:	330-788-2487
Fax Number	:	330-788-2487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2013
Last Update Date	:	09/15/2014

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