Healthcare Provider Details

I. General information

NPI: 1548065196
Provider Name (Legal Business Name): AMBER GUERRERO CHW, LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N SOLANO DR
LAS CRUCES NM
88001-2371
US

IV. Provider business mailing address

PO BOX 3948
ANTHONY NM
88021-3948
US

V. Phone/Fax

Practice location:
  • Phone: 915-471-7802
  • Fax:
Mailing address:
  • Phone: 915-471-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number56512
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-1579
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: