Individual
ADA GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-3210
(631) 444-0650
Mailing address
93 CARTER ST, BAY SHORE, NY 11706-4505
(631) 747-2154
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
609093-1
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
306547
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
306547
NEW YORK STATE EDUCATION DEPARTMENT
NY
05
—
609093-1
—
NY
Enumeration date
07/06/2010
Last updated
08/16/2024
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