Healthcare Provider Details

I. General information

NPI: 1174330179
Provider Name (Legal Business Name): JACQUELINE MICHELLE GUTIERREZ BCDNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13218 NE 56TH AVE
VANCOUVER WA
98686-4923
US

IV. Provider business mailing address

9208 NE HIGHWAY 99 STE. 107 #393
VANCOUVER WA
98665
US

V. Phone/Fax

Practice location:
  • Phone: 702-703-7357
  • Fax:
Mailing address:
  • Phone: 702-703-7357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: