Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 49995 | MN |
Y | 208600000X | Surgeon | 49995 | MN |
NPI | 1003058355 |
---|---|
Provider Name | Jessica M Gutierrez |
First Address | Minneapolis, MN 55404-4522 |
Second Address | Minneapolis, MN 55404-4522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 20/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |