MEDICARE: ANDREW S GUINIGUNDO CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0200X	Oncology Registered Nurse	RN260103	OH
2	363LA2200X	Adult Health Nurse Practitioner	3003467	KY
3	363LA2200X	Adult Health Nurse Practitioner	06512-NP	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	500019639	OTHER	KY	MEDICARE RAILROAD
4	500019634	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124083407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW S GUINIGUNDO CNP

Provider Business Mailing Address
First Line	:	5053 WOOSTER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45226-2326
Country	:	US
Telephone Number	:	513-751-2273
Fax Number	:	513-751-2138

Provider Business Practice Location Address
First Line	:	4350 MALSBARY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5621
Country	:	US
Telephone Number	:	513-751-2273
Fax Number	:	513-792-5844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	04/22/2021

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