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NPI Code Detail

MEDICARE: FANNY D GUARNIZO MILLER MSW STUDENT

MEDICARE: FANNY D GUARNIZO MILLER MSW STUDENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1063972677
Entity Type Code : Individual
Provider Name (Legal Business Name) : FANNY D GUARNIZO MILLER MSW STUDENT
Provider Business Mailing Address
First Line : 3901 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-2614
Country : US
Telephone Number : 612-824-0415
Fax Number :
Provider Business Practice Location Address
First Line : 3901 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-2614
Country : US
Telephone Number : 612-824-0415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 03/20/2019

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