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General NPI Number Information
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NPI Number | 1831851278
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Entity Type | Individual
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Provider Name | JILLIAN ILLYSE GUTIERREZ NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 30 W WARD ST
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City | SPRINGFIELD
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State | OH
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Zip | 45504
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Country | US
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Telephone | 937-328-2310
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Fax |
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Provider Business Mailing Address
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Address Line | 3697 BALLENTINE PIKE
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City | SPRINGFIELD
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State | OH
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Zip | 45502-8669
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Country | US
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Telephone | 937-925-5475
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0029862
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License Number State | OH
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