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NPI Code Detail

MEDICARE: DEEANNA GUTIERREZ

MEDICARE: DEEANNA 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
1106S00000XBehavior TechnicianABAT-13029NC

General Provider Information

NPI Number : 1427771146
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEEANNA GUTIERREZ
Provider Business Mailing Address
First Line : 2919 BREEZEWOOD AVE
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-5501
Country : US
Telephone Number : 910-484-1711
Fax Number :
Provider Business Practice Location Address
First Line : 102 SUPERIOR DR
Second Line :
City : SPRING LAKE
State : NC
Zip : 28390-3190
Country : US
Telephone Number : 910-484-1711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2022
Last Update Date : 09/20/2022

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Directions to “ DEEANNA GUTIERREZ ” Practice Location

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