Provider Demographics
NPI:1003886540
Name:GUTWILLIG, STEVEN B (ARNP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:B
Last Name:GUTWILLIG
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5507
Mailing Address - Country:US
Mailing Address - Phone:978-534-8701
Mailing Address - Fax:978-534-8705
Practice Address - Street 1:87 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5507
Practice Address - Country:US
Practice Address - Phone:978-534-8701
Practice Address - Fax:978-534-8705
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05095723363LF0000X, 363LF0000X
MA253069363LF0000X
MARN253069363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30343142Medicaid
NH30343142Medicaid
MANP474403Medicare PIN
MANP4744Medicare PIN