Provider Demographics
NPI:1295705572
Name:GUTIERREZ, LORI A (WHCNP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3054
Mailing Address - Country:US
Mailing Address - Phone:218-829-2861
Mailing Address - Fax:
Practice Address - Street 1:13060 ISLE DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8331
Practice Address - Country:US
Practice Address - Phone:218-828-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR128792-9363LW0102X
MN3019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1107621OtherAMERICA'S PPO (ARAZ)
MN68G09GUOtherBCBS MN
MN345497500Medicaid
07-01383OtherMEDICA
44526OtherSIOUX VALLEY HEALTH PLAN
HP31350OtherHEALTH PARTNERS
1025619OtherPREFERRED ONE
140102OtherUCARE
44526OtherSIOUX VALLEY HEALTH PLAN
MN345497500Medicaid