Healthcare Provider Details

I. General information

NPI: 1720342322
Provider Name (Legal Business Name): GWENDOLYN JEAN GUCK B.S.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 OLD SONOMA RD BLDG G
NAPA CA
94559-3708
US

IV. Provider business mailing address

PO BOX 5926
NAPA CA
94581-0926
US

V. Phone/Fax

Practice location:
  • Phone: 707-975-2241
  • Fax:
Mailing address:
  • Phone: 707-975-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number771980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: