Provider Demographics
NPI:1750885885
Name:GUTIERREZ, WILLI PATRICE (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:WILLI
Middle Name:PATRICE
Last Name:GUTIERREZ
Suffix:
Gender:
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-3818
Mailing Address - Country:US
Mailing Address - Phone:940-631-0480
Mailing Address - Fax:844-972-1555
Practice Address - Street 1:2102 HAYES ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-3818
Practice Address - Country:US
Practice Address - Phone:940-631-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6057548163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant