Provider Demographics
NPI:1174542930
Name:HUTSKO, GARY MARK (CRNP)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:MARK
Last Name:HUTSKO
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 LOYALVILLE OUTLET RD
Mailing Address - Street 2:
Mailing Address - City:HARVEYS LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18618-2114
Mailing Address - Country:US
Mailing Address - Phone:570-477-5995
Mailing Address - Fax:
Practice Address - Street 1:1111 E END BLVD
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0030
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN282074LOtherREGISTERED NURSE
PASP007081OtherNURSE PRACTITIONER
PA055209PGYMedicare PIN
PAP51520Medicare UPIN