Healthcare Provider Details

I. General information

NPI: 1831912682
Provider Name (Legal Business Name): HEATHER LYNN GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 S LAKESHORE DR STE 2
TEMPE AZ
85282-7161
US

IV. Provider business mailing address

3501 E AMBER LN
GILBERT AZ
85296-1840
US

V. Phone/Fax

Practice location:
  • Phone: 623-462-3344
  • Fax: 623-334-2741
Mailing address:
  • Phone: 480-717-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number316207
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: