Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | SP019230 | PA |
NPI | 1629564307 |
---|---|
Provider Name | Mrs. Ana Luisa Perez Guerrero |
First Address | Glassboro, NJ 08028-3013 |
Second Address | Philadelphia, PA 19139-1401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2018 |
Last Update Date | 21/09/2018 |