Healthcare Provider Details

I. General information

NPI: 1548557291
Provider Name (Legal Business Name): THELMA DUMAPIT GUZMAN RN, MS, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 01/24/2021
Certification Date: 01/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 BROADWAY
NEWARK NJ
07104-4309
US

IV. Provider business mailing address

153 AUTUMN RIDGE RD
MORRIS PLAINS NJ
07950-1198
US

V. Phone/Fax

Practice location:
  • Phone: 973-214-4383
  • Fax: 973-455-0601
Mailing address:
  • Phone: 973-214-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00018600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: