MEDICARE: PAOLA CRISTINA GUEVARA RN

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	163W00000X	Registered Nurse	708647	NY

General Provider Information

NPI Number	:	1407229271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA CRISTINA GUEVARA RN

Provider Business Mailing Address
First Line	:	7901 35TH AVE APT 1C
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2715
Country	:	US
Telephone Number	:	917-238-8430
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 35TH AVE APT 1C
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2715
Country	:	US
Telephone Number	:	917-238-8430
Fax Number	:

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

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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