Healthcare Provider Details

I. General information

NPI: 1659365500
Provider Name (Legal Business Name): KAREN L GUTIERREZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 PARK CLUB LN
WILLIAMSVILLE NY
14221-5270
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD STE 208
NORTH TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-422-0010
  • Fax: 716-422-0618
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-692-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number331702
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: