Individual
GARY WAYNE TUTHILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
901 9TH ST N, VIRGINIA, MN 55792-2348
(218) 741-3340
Mailing address
6802 TAMARACK RD, VIRGINIA, MN 55792-8022
(218) 749-3197
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R125505-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760149-00
—
MN
Enumeration date
08/12/2005
Last updated
07/11/2007
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