Provider Demographics
NPI:1982327128
Name:GUTIERREZ, BIANCA FERNANDEZ (LMT, NAC)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:FERNANDEZ
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMT, NAC
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:FERNANDEZ GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, NAC
Mailing Address - Street 1:4339 W KENNEWICK AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2802
Mailing Address - Country:US
Mailing Address - Phone:509-735-0311
Mailing Address - Fax:509-783-1206
Practice Address - Street 1:4339 W KENNEWICK AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2802
Practice Address - Country:US
Practice Address - Phone:509-735-0311
Practice Address - Fax:509-783-1206
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60976611376K00000X
WAMA61228534225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide