Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00174000 | NJ |
NPI | 1003021700 |
---|---|
Provider Name | Susan Madeleine Guerra |
First Address | Cinnaminson, NJ 08077-3534 |
Second Address | Linwood, NJ 08221-1046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 26/09/2018 |