MEDICARE: MRS. ADRIANE GUERIN PA C

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	363A00000X	Physician Assistant	000431	CT

General Provider Information

NPI Number	:	1588699557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADRIANE GUERIN PA C

Provider Business Mailing Address
First Line	:	179 ROSELAND AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06710
Country	:	US
Telephone Number	:	203-574-4747
Fax Number	:	203-574-2251

Provider Business Practice Location Address
First Line	:	179 ROSELAND AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06710
Country	:	US
Telephone Number	:	203-574-4747
Fax Number	:	203-574-2251

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	02/02/2012

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