Healthcare Provider Details

I. General information

NPI: 1992196703
Provider Name (Legal Business Name): SCOTT RYAN GUTIERREZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 22ND ST SUITE 610
OAK BROOK IL
60523-2006
US

IV. Provider business mailing address

315 ARCH ST APT 603
PHILADELPHIA PA
19106-1800
US

V. Phone/Fax

Practice location:
  • Phone: 630-537-1720
  • Fax: 630-537-1724
Mailing address:
  • Phone: 303-912-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0994097-CRNA
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN633564
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: