=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225581531
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISA ALVA GUTIERREZ FNP - C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2016
-----------------------------------------------------
Last Update Date | 09/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 N US HIGHWAY 83
-----------------------------------------------------
City | ZAPATA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78076-3290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-765-8494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7215 MCPHERSON RD
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-6554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-728-0323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP130982
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------