1558457309 NPI number — MS. ANNABELLE X. GUTIERREZ SISNEROS APRN, BC MSN CCM MA

Table of content: MS. ANNABELLE X. GUTIERREZ SISNEROS APRN, BC MSN CCM MA (NPI 1558457309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558457309 NPI number — MS. ANNABELLE X. GUTIERREZ SISNEROS APRN, BC MSN CCM MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTIERREZ SISNEROS
Provider First Name:
ANNABELLE
Provider Middle Name:
X.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC MSN CCM MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORA
Provider Other First Name:
ANA
Provider Other Middle Name:
GUTIERREZ
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, ADN BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558457309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1845
Provider Second Line Business Mailing Address:
1120 INDUSTRIAL PARK RD., SUITE 401
Provider Business Mailing Address City Name:
ESPANOLA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87532-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-690-0213
Provider Business Mailing Address Fax Number:
505-747-2965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 INDUSTRIAL PARK RD, SUITE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-690-0213
Provider Business Practice Location Address Fax Number:
505-747-2965
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X , with the licence number:  R22377 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 59870788 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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