Healthcare Provider Details

I. General information

NPI: 1801036355
Provider Name (Legal Business Name): LAURA LEE GUZMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CUMBERLAND PL SUITE 108
BANGOR ME
04401-5083
US

IV. Provider business mailing address

1 CUMBERLAND ST SUITE 108
BANGOR ME
04401
US

V. Phone/Fax

Practice location:
  • Phone: 207-990-9000
  • Fax: 207-941-8645
Mailing address:
  • Phone: 207-990-9000
  • Fax: 207-941-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR038778
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: