Healthcare Provider Details

I. General information

NPI: 1528615028
Provider Name (Legal Business Name): WENDY JEAN GUZMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY JEAN ORR RN

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CLIFTON AVE
MINNEAPOLIS MN
55403-3467
US

IV. Provider business mailing address

2060 CENTRE POINTE BLVD STE 3
SAINT PAUL MN
55120-1271
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-2071
  • Fax: 612-870-3789
Mailing address:
  • Phone: 651-774-0011
  • Fax: 612-870-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR167812-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: