Provider Demographics
NPI:1366685182
Name:GUTIERREZ, ROSALINDA (RT)
Entity Type:Individual
Prefix:MS
First Name:ROSALINDA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRINGS
Mailing Address - State:NE
Mailing Address - Zip Code:69122-2284
Mailing Address - Country:US
Mailing Address - Phone:402-215-7370
Mailing Address - Fax:
Practice Address - Street 1:300 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BIG SPRINGS
Practice Address - State:NE
Practice Address - Zip Code:69122-2284
Practice Address - Country:US
Practice Address - Phone:402-215-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR0007873247100000X
WV8287247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist