Provider Demographics
NPI:1174330179
Name:GUTIERREZ, JACQUELINE MICHELLE (BCDNM)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MICHELLE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:BCDNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 NE HIGHWAY 99 STE. 107 #393
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665
Mailing Address - Country:US
Mailing Address - Phone:702-703-7357
Mailing Address - Fax:
Practice Address - Street 1:13218 NE 56TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-4923
Practice Address - Country:US
Practice Address - Phone:702-703-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No174H00000XOther Service ProvidersHealth Educator