Provider Demographics
NPI:1023329984
Name:GUTIERREZ, LINDSEY ALLISON (LPN)
Entity type:Individual
Prefix:MISS
First Name:LINDSEY
Middle Name:ALLISON
Last Name:GUTIERREZ
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 1:57 W TIANA RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-3626
Mailing Address - Country:US
Mailing Address - Phone:631-977-1282
Mailing Address - Fax:
Practice Address - Street 1:71 LAKEWOOD CT
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-2056
Practice Address - Country:US
Practice Address - Phone:631-521-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297623-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse