Healthcare Provider Details

I. General information

NPI: 1386080588
Provider Name (Legal Business Name): ANGELA M. GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 PHALEN BLVD
SAINT PAUL MN
55130-2400
US

IV. Provider business mailing address

8170 33RD AVE S MS: 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-495-6603
  • Fax: 651-495-6201
Mailing address:
  • Phone: 651-254-7900
  • Fax: 651-254-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR1356290
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP 2908
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP2908
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: