Provider Demographics
NPI:1497177240
Name:DUTCHER, JUSTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:DUTCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12620 PERRY HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8662
Mailing Address - Country:US
Mailing Address - Phone:877-660-6777
Mailing Address - Fax:247-933-6620
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:877-660-6777
Practice Address - Fax:412-359-8055
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA155779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant