Healthcare Provider Details

I. General information

NPI: 1629890793
Provider Name (Legal Business Name): ERIKA GUEVARRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MICHIGAN AVE
CHICAGO IL
60611-4255
US

IV. Provider business mailing address

4714 W IRVING PARK RD APT 315
CHICAGO IL
60641-1215
US

V. Phone/Fax

Practice location:
  • Phone: 312-635-0973
  • Fax:
Mailing address:
  • Phone: 248-417-0854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number041.485664
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: