Healthcare Provider Details

I. General information

NPI: 1023735651
Provider Name (Legal Business Name): ERIN RENEE GUTIERREZ RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 NW 56TH ST
OKLAHOMA CITY OK
73112-4518
US

IV. Provider business mailing address

14025 N EASTERN AVE APT 1819
EDMOND OK
73013-5767
US

V. Phone/Fax

Practice location:
  • Phone: 405-606-6937
  • Fax:
Mailing address:
  • Phone: 580-551-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2769
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: