Healthcare Provider Details

I. General information

NPI: 1285030627
Provider Name (Legal Business Name): LAUREN GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E BALTIMORE PIKE
MEDIA PA
19063-3836
US

IV. Provider business mailing address

510 E BALTIMORE PIKE
MEDIA PA
19063-3836
US

V. Phone/Fax

Practice location:
  • Phone: 610-566-3218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014485
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: