Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 125666 | MO |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 125666 | MO |
NPI | 1356366405 |
---|---|
Provider Name | Mrs. Susan M Gutierrez |
First Address | Joplin, MO 64804-4524 |
Second Address | Joplin, MO 64804-4524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 10/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
185426 | BCBS (01) | MO |
200022690A | (05) | OK |
200253250D | (05) | KS |
428980205 | (05) | MO |
P01080619 | RAIL ROAD MEDICARE (01) | MO |
Q00520 | (02) |