Provider Demographics
NPI:1912661968
Name:GUTIERREZ, PAMELA JANE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 W HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-1201
Mailing Address - Country:US
Mailing Address - Phone:812-829-4437
Mailing Address - Fax:
Practice Address - Street 1:279 W HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1201
Practice Address - Country:US
Practice Address - Phone:812-829-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN390200000X
IN71012361A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program