Healthcare Provider Details

I. General information

NPI: 1992793814
Provider Name (Legal Business Name): LAURA GUERRA F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LYCOMING AVE
MCKINLEYVILLE CA
95519-9308
US

IV. Provider business mailing address

2155 PLUNKETT RD
BAYSIDE CA
95524-9701
US

V. Phone/Fax

Practice location:
  • Phone: 707-839-6115
  • Fax: 707-839-6178
Mailing address:
  • Phone: 707-826-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: