Healthcare Provider Details

I. General information

NPI: 1174045520
Provider Name (Legal Business Name): GENEVIEVE JO GUTIERREZ DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GENEVIEVE JO GUTIERREZ NP-C

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WALTER ST NE STE 401
ALBUQUERQUE NM
87102-2563
US

IV. Provider business mailing address

4101 INDIAN SCHOOL RD NE STE 110
ALBUQUERQUE NM
87110-3991
US

V. Phone/Fax

Practice location:
  • Phone: 316-689-9111
  • Fax:
Mailing address:
  • Phone: 505-727-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77765
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: