Basic Information
| Provider Information | |||||||||
| NPI: | 1205833779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1091 KIRKPATRICK RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272159714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365381880 | ||||||||
| FaxNumber: | 3365381895 | ||||||||
| Practice Location | |||||||||
| Address1: | 1091 KIRKPATRICK RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272159714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365381880 | ||||||||
| FaxNumber: | 3365381895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 154799 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.