Provider Demographics
NPI:1033101852
Name:HUTZELL, GLORIA JEAN (CRFNP)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JEAN
Last Name:HUTZELL
Suffix:
Gender:F
Credentials:CRFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6946
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-0946
Mailing Address - Country:US
Mailing Address - Phone:610-372-9222
Mailing Address - Fax:610-372-0232
Practice Address - Street 1:655 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1242
Practice Address - Country:US
Practice Address - Phone:619-372-9222
Practice Address - Fax:610-372-0232
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102579977Medicaid