Provider Demographics
NPI:1790552925
Name:GUTIERREZ, INDIRA (APRN)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2766 S TARPAN RD
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-1944
Mailing Address - Country:US
Mailing Address - Phone:801-808-4178
Mailing Address - Fax:801-808-4178
Practice Address - Street 1:8087 W 3500 S
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-2218
Practice Address - Country:US
Practice Address - Phone:801-808-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT124806743102163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology