Provider Demographics
NPI:1972265072
Name:GUTU, ALICE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:
Last Name:GUTU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9122
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01853-9122
Mailing Address - Country:US
Mailing Address - Phone:978-401-1773
Mailing Address - Fax:
Practice Address - Street 1:86 WIGHTMAN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1517
Practice Address - Country:US
Practice Address - Phone:978-401-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311810163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health