Edna Gail Gutierrez, CNP
Individual provider Active NPI Family Nurse Practitioner · Melrose, NM
NPI 1376536854 · NPPES record last updated Aug 16, 2016
Key facts
- NPI
- 1376536854
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- CNP00610 (NM)
- Practice address
- 121 N. Main
Melrose, NM 88124 - Phone
- (575) 253-4373
- Fax
- (575) 253-4575
- NPI assigned
- Aug 30, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050328001095 | NM | Practitioner - Nurse Practitioner | 7113829060 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP00610 | NM | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| De Baca Family Practice Clinic | Current |
Accepting new patients | |
| De Baca Family Practice Clinic | Current |
Accepting new patients | |
| Alignmed Partners, PC | Current |
Accepting new patients | |
| Valley Emergency Physicians New Mexico PC | Past | Accepting new patients | |
| Lea Emergency Group LLC | Past | Accepting new patients | |
| Clovis Family Health Care Center LLC | Past |
Accepting new patients | |
| David a Stalker MD PA | Past | Accepting new patients | |
| Via Christi Medical Clinic, Inc. | Past | Accepting new patients |
Locations
5123 Juan Tabo Blvd NE
Albuquerque, NM 87111
Phone (505) 292-3333
1831 Camino del Llano
Belen, NM 87002
Phone (505) 864-1600
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/DGGJCD
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R30396 | NM | |
| Family Nurse Practitioner | 363LF0000X | CNP00610 | NM | Yes |
Addresses
Primary practice location
121 N. Main
Melrose, NM 88124
Mailing address
PO Box 299
Portales, NM 88130-0299
Phone (575) 356-6652
Other names
- Edna Gail Johnson
Other providers in Melrose, NM
- Amy Coddington
- Tammie Jean Jacobs
- Zanessa D. Kastler
- La Casa de Buena Salud Inc
- Karla Annette Moore
- Roosevelt County Special Hospital District
All providers in Melrose, NM · Family Nurse Practitioner in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.