Healthcare Provider Details

I. General information

NPI: 1336652098
Provider Name (Legal Business Name): MARIA GUADALUPE AGUADO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N 18TH ST
MOUNT VERNON WA
98273-3902
US

IV. Provider business mailing address

1710 E FIR ST
MOUNT VERNON WA
98273-2556
US

V. Phone/Fax

Practice location:
  • Phone: 360-848-6616
  • Fax: 360-588-5565
Mailing address:
  • Phone: 360-941-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN60466786
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: