Healthcare Provider Details

I. General information

NPI: 1801892468
Provider Name (Legal Business Name): MS. MARY MARGARET GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY GUERRA NP

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE RD
TROY MI
48085-1117
US

IV. Provider business mailing address

42494 BOBJEAN ST
STERLING HEIGHTS MI
48314-3124
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-4162
  • Fax:
Mailing address:
  • Phone: 586-254-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704126642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: