Provider Demographics
NPI:1235684242
Name:GUTIERREZ, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S 33RD ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-5238
Mailing Address - Country:US
Mailing Address - Phone:254-215-7404
Mailing Address - Fax:254-215-6193
Practice Address - Street 1:1100 S 33RD ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5238
Practice Address - Country:US
Practice Address - Phone:254-215-7404
Practice Address - Fax:254-215-6193
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator