Basic Information
| Provider Information | |||||||||
| NPI: | 1720022809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | MARIAN | ||||||||
| MiddleName: | NABONG | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 531768 | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785531768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563896565 | ||||||||
| FaxNumber: | 9563896567 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 PEASE ST | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563896565 | ||||||||
| FaxNumber: | 9563896567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 09/22/2015 | ||||||||
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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 | 363LF0000X | 609885 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 286648503 | 05 | TX | MEDICAID |