Provider Demographics
NPI:1194396796
Name:GUTIERREZ, MELEAHA KATHLEEN
Entity Type:Individual
Prefix:
First Name:MELEAHA
Middle Name:KATHLEEN
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 WILDERNESS HILL BLVD APT 7-204
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5185
Mailing Address - Country:US
Mailing Address - Phone:402-640-4364
Mailing Address - Fax:
Practice Address - Street 1:3130 WILDERNESS HILL BLVD APT 7-204
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5185
Practice Address - Country:US
Practice Address - Phone:402-640-4364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74209163WE0003X
WAAP61327724367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WE0003XNursing Service ProvidersRegistered NurseEmergency