Healthcare Provider Details

I. General information

NPI: 1164105805
Provider Name (Legal Business Name): DESTINY MARI GUZMAN RNBSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SUFFERN PL STE A
SUFFERN NY
10901-5566
US

IV. Provider business mailing address

114 PROSPECT HILL RD UNIT 2
WALLKILL NY
12589-2925
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4500
  • Fax:
Mailing address:
  • Phone: 702-832-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number899343-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: