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NPI Code Detail

MEDICARE: LAUREN GUTIERREZ

MEDICARE: LAUREN 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
1363LF0000XFamily Nurse PractitionerSP014485PA

General Provider Information

NPI Number : 1285030627
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN GUTIERREZ
Provider Business Mailing Address
First Line : 510 E BALTIMORE PIKE
Second Line :
City : MEDIA
State : PA
Zip : 19063-3836
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 510 E BALTIMORE PIKE
Second Line :
City : MEDIA
State : PA
Zip : 19063-3836
Country : US
Telephone Number : 610-566-3218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2014
Last Update Date : 11/14/2017

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Directions to “ LAUREN GUTIERREZ ” Practice Location

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