Provider Demographics
NPI:1659462208
Name:HUTSON, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:HUTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 PULLMAN DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-7921
Mailing Address - Country:US
Mailing Address - Phone:775-432-1343
Mailing Address - Fax:775-324-0858
Practice Address - Street 1:1441 PULLMAN DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-7921
Practice Address - Country:US
Practice Address - Phone:775-432-1343
Practice Address - Fax:775-324-0858
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9829207VF0040X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP01166079OtherRAILROAD MEDICARE
NVDT6227OtherRAILROAD MEDICARE
NV002016855Medicaid
NVG50356Medicare UPIN
NVV35404Medicare PIN
NVDT6227OtherRAILROAD MEDICARE
NV002016855Medicaid