Provider Demographics
NPI:1053486654
Name:DUTKO, JOANN (PA-C)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:DUTKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 EAST END CENTRE
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-825-8741
Mailing Address - Fax:570-825-8990
Practice Address - Street 1:ROUTE 29
Practice Address - Street 2:MONROE-NOXEN HEALTH CENTER
Practice Address - City:NOXEN
Practice Address - State:PA
Practice Address - Zip Code:18636-9766
Practice Address - Country:US
Practice Address - Phone:570-298-2121
Practice Address - Fax:570-298-2148
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001781L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA757705Medicare UPIN