=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942830229
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAYLOR ANN GUTIERREZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2020
-----------------------------------------------------
Last Update Date | 01/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6301 INDUCON DR E
-----------------------------------------------------
City | SANBORN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14132-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-631-2030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1048 RIDGE RD
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14092-9704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-703-8780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 337272
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------