Individual
EDGAR ALLAN GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8122 SE TIBBETTS ST, PORTLAND, OR 97206-1768
(503) 255-1111
Mailing address
5750 SE TRANQUIL CT, MILWAUKIE, OR 97267-4343
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200341187-RN
OR
363LF0000X
Family Nurse Practitioner
Primary
201405804NP-PP
OR
Other
Enumeration date
01/18/2013
Last updated
12/29/2021
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