Healthcare Provider Details

I. General information

NPI: 1497294987
Provider Name (Legal Business Name): NADIA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 THOUSAND OAKS BLVD
GEORGETOWN TX
78628-8757
US

IV. Provider business mailing address

103 THOUSAND OAKS BLVD
GEORGETOWN TX
78628-8757
US

V. Phone/Fax

Practice location:
  • Phone: 512-869-4800
  • Fax:
Mailing address:
  • Phone: 512-869-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG02170067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: