MEDICARE: JESSICA GUAN RN

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
1	367500000X	Certified Registered Nurse Anesthetist	26NR27053500	NJ

General Provider Information

NPI Number	:	1427762293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GUAN RN

Provider Business Mailing Address
First Line	:	742 MARCELLUS DR
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-2013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 OLD SHORT HILLS RD
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-5672
Country	:	US
Telephone Number	:	973-322-5512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	03/11/2026

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