Provider Demographics
NPI:1053528489
Name:GUTFELD, GLORIA A (RN)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:A
Last Name:GUTFELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SOUTH KIPLING ST.
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:303-239-7052
Mailing Address - Fax:303-239-7088
Practice Address - Street 1:260 SOUTH KIPLING ST.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-239-7052
Practice Address - Fax:303-239-7088
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN309597364S00000X, 364SC1501X
CO1619291163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP161899OtherCCS PROVIDER #
CO28509510Medicaid