MEDICARE: JOANNE GUTIERREZ RN

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	163WH0200X	Home Health Registered Nurse	177052-30	WI

General Provider Information

NPI Number	:	1881064541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE GUTIERREZ RN

Provider Business Mailing Address
First Line	:	1536 SHORT ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3758
Country	:	US
Telephone Number	:	210-919-3136
Fax Number	:

Provider Business Practice Location Address
First Line	:	1536 SHORT ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3758
Country	:	US
Telephone Number	:	210-919-3136
Fax Number	:

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

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	10/06/2015

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