Provider Demographics
NPI:1861632119
Name:GUTTILLA, DEANNA RAE (NP; RN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:RAE
Last Name:GUTTILLA
Suffix:
Gender:F
Credentials:NP; RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2500
Mailing Address - Country:US
Mailing Address - Phone:602-263-4269
Mailing Address - Fax:
Practice Address - Street 1:5651 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2500
Practice Address - Country:US
Practice Address - Phone:602-263-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN080109364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health