Individual provider Active NPI

Lia Sloan Gutierrez, APRN, FNP-BC

  • Nurse Practitioner
  • Minnetonka, MN
National Provider Identifier
1881685907
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
600636 Issued in TX
Practice address
9900 Bren Rd E
Minnetonka, MN 55343-9664
Phone
(210) 884-3308
NPI assigned
Oct 31, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 600636 TX Primary

Addresses

Primary practice location

9900 Bren Rd E
Minnetonka, MN 55343-9664

Mailing address

496 Chinkapin TRL
New Braunfels, TX 78132-2979
Phone (210) 884-3308

Other practice location 1

5401 Fm 1626
Kyle, TX 78640-6038
Phone (512) 268-1940

Other identifiers 2

IdentifierTypeStateIssuer
088294603MedicaidTX
88N454OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
600636TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Whiteglove Medical Care - NJ, PC Nurse Practitioner PastSince Mar 4, 2014 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1881685907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "496 CHINKAPIN TRL",
            "city": "NEW BRAUNFELS",
            "state": "TX",
            "postal_code": "781322979",
            "telephone_number": "210-884-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 BREN RD E",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553439664",
            "telephone_number": "210-884-3308"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5401 Fm 1626",
            "address_purpose": "LOCATION",
            "city": "Kyle",
            "state": "TX",
            "postal_code": "786406038",
            "country_code": "US",
            "telephone_number": "512-268-1940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "LIA",
        "middle_name": "SLOAN",
        "credential": "APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-31",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "600636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088294603",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "88N454",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.