Healthcare Provider Details

I. General information

NPI: 1831603380
Provider Name (Legal Business Name): AALIYAH LOUISE GUZMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5519 N 37TH ST
MILWAUKEE WI
53209-4733
US

IV. Provider business mailing address

5519 N 37TH ST
MILWAUKEE WI
53209-4733
US

V. Phone/Fax

Practice location:
  • Phone: 414-243-2439
  • Fax:
Mailing address:
  • Phone: 414-243-2439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number237384-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: