Healthcare Provider Details

I. General information

NPI: 1982937298
Provider Name (Legal Business Name): VIRGINIA RUTH GUTIERREZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RESERVOIR ST SUITE 25
NEEDHAM MA
02494-3149
US

IV. Provider business mailing address

220 RESERVOIR ST SUITE 25
NEEDHAM MA
02494-3149
US

V. Phone/Fax

Practice location:
  • Phone: 781-449-8900
  • Fax: 781-449-8911
Mailing address:
  • Phone: 781-449-8900
  • Fax: 781-449-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN169789
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: