Basic Information
| Provider Information | |||||||||
| NPI: | 1366794174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | INGRID | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12221 MERIT DR. | ||||||||
| Address2: | STE. 1500 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142171900 | ||||||||
| FaxNumber: | 2142171912 | ||||||||
| Practice Location | |||||||||
| Address1: | 12221 MERIT DR. | ||||||||
| Address2: | STE 1500 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142171900 | ||||||||
| FaxNumber: | 2142171912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2012 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP123391 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.