Provider Demographics
NPI:1508134883
Name:GUTIERREZ, TRACY JOY (MT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:JOY
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 H STREET EAST
Mailing Address - Street 2:LABORATORY
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-0067
Mailing Address - Country:US
Mailing Address - Phone:406-768-2172
Mailing Address - Fax:406-768-3435
Practice Address - Street 1:107 H STREET EAST
Practice Address - Street 2:LABORATORY
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255-0067
Practice Address - Country:US
Practice Address - Phone:406-768-2172
Practice Address - Fax:406-768-3435
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical