Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | A1007099 | NJ |
NPI | 1013174085 |
---|---|
Provider Name | Mrs. Marissa Solis Guzman |
First Address | Fair Haven, NJ 07704-3102 |
Second Address | Fair Haven, NJ 07704-3102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 23/09/2008 |