Provider Demographics
NPI:1790361897
Name:GUTIERREZ PADILLA, NOHEMI (LPN)
Entity Type:Individual
Prefix:
First Name:NOHEMI
Middle Name:
Last Name:GUTIERREZ PADILLA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 BLUE WATER DR
Mailing Address - Street 2:
Mailing Address - City:BELEWS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27009-9617
Mailing Address - Country:US
Mailing Address - Phone:336-671-5780
Mailing Address - Fax:
Practice Address - Street 1:1906 ALYSSUM PL
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7557
Practice Address - Country:US
Practice Address - Phone:336-671-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89127164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127OtherPHONE DISCOUNT