Healthcare Provider Details

I. General information

NPI: 1063738250
Provider Name (Legal Business Name): GINA GUILLANO MCMANUS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3093 FEARN PL
BRONX NY
10465-4111
US

IV. Provider business mailing address

3093 FEARN PL
BRONX NY
10465-4111
US

V. Phone/Fax

Practice location:
  • Phone: 917-513-1735
  • Fax: 718-829-6613
Mailing address:
  • Phone: 917-513-1735
  • Fax: 718-829-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number5859911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: