Provider Demographics
NPI:1598014623
Name:DUTKO, ERIK D (CRNP)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:D
Last Name:DUTKO
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2536
Mailing Address - Country:US
Mailing Address - Phone:484-521-2892
Mailing Address - Fax:
Practice Address - Street 1:53 N UNION AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2536
Practice Address - Country:US
Practice Address - Phone:484-521-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN618839163W00000X
PASP021096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103733418-0001Medicaid
PA103733418-0002Medicaid
PA103733418-0003Medicaid