Provider Demographics
NPI:1356001655
Name:GUTIERREZ, SANDRA RAE (RN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:RAE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:RAE
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5010 W TRIANGLE LEAF CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3948
Mailing Address - Country:US
Mailing Address - Phone:520-351-2399
Mailing Address - Fax:
Practice Address - Street 1:5010 W TRIANGLE LEAF CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3948
Practice Address - Country:US
Practice Address - Phone:520-351-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN153720163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical