Provider Demographics
NPI:1902595804
Name:GUTIERREZ, NATASHA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MONTGOMERY CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-4427
Mailing Address - Country:US
Mailing Address - Phone:347-200-4201
Mailing Address - Fax:
Practice Address - Street 1:130 MONTGOMERY CIR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-4427
Practice Address - Country:US
Practice Address - Phone:347-200-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351705-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine