MEDICARE: NICHOLE GUTIERREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1194658146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE GUTIERREZ

Provider Business Mailing Address
First Line	:	2818 MOYA RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2817
Country	:	US
Telephone Number	:	505-328-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2818 MOYA RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2817
Country	:	US
Telephone Number	:	505-328-6440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ NICHOLE GUTIERREZ ” Practice Location

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