Basic Information
| Provider Information | |||||||||
| NPI: | 1174542930 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUTSKO | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1087 LOYALVILLE OUTLET RD | ||||||||
| Address2: | |||||||||
| City: | HARVEYS LAKE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186182114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704775995 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 E END BLVD | ||||||||
| Address2: | VA MEDICAL CENTER | ||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187110030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708243521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP007081 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | RN282074L | 01 | PA | REGISTERED NURSE | OTHER | SP007081 | 01 | PA | NURSE PRACTITIONER | OTHER |