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General NPI Number Information
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NPI Number | 1144877218
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Entity Type | Individual
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Provider Name | DIANA LEE GUTIERREZ AGACNP
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Gender | Female
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 1009 GOLF COURSE RD SE STE 109
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City | RIO RANCHO
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State | NM
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Zip | 87124-4705
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Country | US
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Telephone | 505-891-3344
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Fax | 505-896-4499
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Provider Business Mailing Address
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Address Line | 1016 QUINTA ANTIGUA LN
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City | EL PASO
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State | TX
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Zip | 79912-2039
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Country | US
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Telephone | 915-779-7378
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | C-APN.0101302-C-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 56997
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 56997
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 56997
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License Number State | NM
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