Individual
MRS. SUSAN M GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
100 MERCY WAY, JOPLIN, MO 64804-4524
(417) 556-2300
(417) 556-2906
Mailing address
100 MERCY WAY, JOPLIN, MO 64804-4524
(417) 556-2300
(417) 556-2906
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
125666
MO
363LF0000X
Family Nurse Practitioner
Primary
125666
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
185426
BCBS
MO
05
—
200022690A
—
OK
05
—
200253250D
—
KS
05
—
428980205
—
MO
01
—
P01080619
RAIL ROAD MEDICARE
MO
Enumeration date
07/12/2006
Last updated
08/10/2016
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