Healthcare Provider Details

I. General information

NPI: 1750885885
Provider Name (Legal Business Name): WILLI PATRICE GUTIERREZ RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 HAYES ST
WICHITA FALLS TX
76309-3818
US

IV. Provider business mailing address

2102 HAYES ST
WICHITA FALLS TX
76309-3818
US

V. Phone/Fax

Practice location:
  • Phone: 940-631-0480
  • Fax:
Mailing address:
  • Phone: 940-631-0480
  • Fax: 844-972-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number6057548
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: