Provider Demographics
NPI:1366794174
Name:GUTIERREZ, INGRID DENISE (NP)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:DENISE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 MERIT DR.
Mailing Address - Street 2:STE. 1500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251
Mailing Address - Country:US
Mailing Address - Phone:214-217-1900
Mailing Address - Fax:214-217-1912
Practice Address - Street 1:12221 MERIT DR.
Practice Address - Street 2:STE 1500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251
Practice Address - Country:US
Practice Address - Phone:214-217-1900
Practice Address - Fax:214-217-1912
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123391363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner