Healthcare Provider Details

I. General information

NPI: 1952601254
Provider Name (Legal Business Name): SHARON ANNE GUTIERREZ PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARON ANNE GUTIERREZ MSN, RN, CPNP

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG. 11335 SSG SIMS ST. BIGGS AF
FT BLISS TX
79918
US

IV. Provider business mailing address

5005 N PIEDRAS ST
EL PASO TX
79920-5001
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-1093
  • Fax:
Mailing address:
  • Phone: 915-742-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number598845
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: