Healthcare Provider Details

I. General information

NPI: 1487297081
Provider Name (Legal Business Name): JULIE C GUTIERREZ DNP, PMHNP-BC, BSN,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JULIE C BROWN

II. Dates (important events)

Enumeration Date: 10/26/2019
Last Update Date: 10/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5180
US

IV. Provider business mailing address

2021 HENDOLA DR NE
ALBUQUERQUE NM
87110-4807
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-440-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number58108
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-70741
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: