Provider Demographics
NPI:1992196703
Name:GUTIERREZ, SCOTT RYAN (CRNA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RYAN
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:315 ARCH ST
Mailing Address - Street 2:APT 603
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1800
Mailing Address - Country:US
Mailing Address - Phone:303-912-2851
Mailing Address - Fax:
Practice Address - Street 1:1301 W 22ND ST
Practice Address - Street 2:SUITE 610
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2006
Practice Address - Country:US
Practice Address - Phone:630-537-1720
Practice Address - Fax:630-537-1724
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN633564367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered