Healthcare Provider Details

I. General information

NPI: 1790453710
Provider Name (Legal Business Name): ANGELA LOUISE GUZZARDO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N 108TH PL
WAUWATOSA WI
53226-4253
US

IV. Provider business mailing address

2821 N 83RD ST
MILWAUKEE WI
53222-4821
US

V. Phone/Fax

Practice location:
  • Phone: 414-231-9640
  • Fax:
Mailing address:
  • Phone: 262-215-3708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number149011-32
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: