Healthcare Provider Details

I. General information

NPI: 1265018584
Provider Name (Legal Business Name): MERLIS OLIVEROS GUERRA ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13555 W MCDOWELL RD STE 205
GOODYEAR AZ
85395-2626
US

IV. Provider business mailing address

13555 W MCDOWELL RD STE 205
GOODYEAR AZ
85395-2626
US

V. Phone/Fax

Practice location:
  • Phone: 623-295-1190
  • Fax:
Mailing address:
  • Phone: 623-295-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number255346
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number255346
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: