Provider Demographics
NPI:1225282528
Name:UTTER, GREGORY (RN)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:UTTER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STATE HIGHWAY 310 STE 2
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1436
Mailing Address - Country:US
Mailing Address - Phone:315-229-3458
Mailing Address - Fax:315-386-2781
Practice Address - Street 1:80 STATE HIGHWAY 310 STE 2
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1436
Practice Address - Country:US
Practice Address - Phone:315-229-3458
Practice Address - Fax:315-386-2781
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY372764163WC0400X, 163W00000X, 171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator