Healthcare Provider Details

I. General information

NPI: 1225881451
Provider Name (Legal Business Name): JULIEANNE GUTIERREZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 W ROOSEVELT ST
PHOENIX AZ
85009-3404
US

IV. Provider business mailing address

3306 W ROOSEVELT ST
PHOENIX AZ
85009-3404
US

V. Phone/Fax

Practice location:
  • Phone: 602-889-9401
  • Fax:
Mailing address:
  • Phone: 602-889-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number305743
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: