Provider Demographics
NPI:1144508144
Name:HUTCHINS, ELIZABETH (ANP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HUTCHINS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-926-1770
Mailing Address - Fax:518-926-1799
Practice Address - Street 1:2 BROAD STREET PLZ
Practice Address - Street 2:BROAD STREET MEDICAL GROUP
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4363
Practice Address - Country:US
Practice Address - Phone:518-926-1770
Practice Address - Fax:518-926-1799
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305797363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03371620Medicaid
NYP00987924OtherRR MEDICARE
NYP00987924OtherRR MEDICARE