Healthcare Provider Details

I. General information

NPI: 1336069053
Provider Name (Legal Business Name): ANGELINA MONIQUE GUEVARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 SUPERIOR ST APT 11
LINCOLN NE
68521-1962
US

IV. Provider business mailing address

1517 SUPERIOR ST APT 11
LINCOLN NE
68521-1962
US

V. Phone/Fax

Practice location:
  • Phone: 402-429-4914
  • Fax:
Mailing address:
  • Phone: 402-429-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberH14275255
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: