Provider Demographics
NPI:1245876846
Name:GUTIERREZ, JESSICA KANDIS (FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KANDIS
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N LARKIN AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3455
Mailing Address - Country:US
Mailing Address - Phone:815-685-4665
Mailing Address - Fax:630-566-3322
Practice Address - Street 1:1106 N LARKIN AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3455
Practice Address - Country:US
Practice Address - Phone:815-685-4665
Practice Address - Fax:630-566-3322
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily