Provider Demographics
NPI:1295510816
Name:GUTIERREZ, SHANNA DOMINICA (LTC HOME CARE, LLC)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:DOMINICA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LTC HOME CARE, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 FOX LN SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3546
Mailing Address - Country:US
Mailing Address - Phone:505-234-4272
Mailing Address - Fax:
Practice Address - Street 1:605 FOX LN SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3546
Practice Address - Country:US
Practice Address - Phone:505-234-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide