Provider Demographics
NPI:1518204973
Name:GUTSHALL, ERICA D (WHNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:D
Last Name:GUTSHALL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 EAST MIDLOTHIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-2021
Mailing Address - Country:US
Mailing Address - Phone:330-788-2487
Mailing Address - Fax:330-788-8620
Practice Address - Street 1:77 EAST MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-2021
Practice Address - Country:US
Practice Address - Phone:330-788-2487
Practice Address - Fax:330-788-2487
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14132NP363LW0102X
OHRN342596163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092109Medicaid
OHH290960Medicare PIN