Provider Demographics
NPI:1205368990
Name:GUTIERREZ, CHANTHY (NP)
Entity Type:Individual
Prefix:
First Name:CHANTHY
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19221 I 45 S STE 430
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8770
Mailing Address - Country:US
Mailing Address - Phone:832-813-5743
Mailing Address - Fax:832-813-8127
Practice Address - Street 1:19221 I 45 S STE 430
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8770
Practice Address - Country:US
Practice Address - Phone:832-813-5743
Practice Address - Fax:832-813-8127
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC290618363LF0000X
TX1050917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily