MEDICARE: KATHERINE S DE GUZMAN

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	163W00000X	Registered Nurse	774840	CA
2	363LF0000X	Family Nurse Practitioner	22228	CA
3	363LF0000X	Family Nurse Practitioner	R253278	MD

General Provider Information

NPI Number	:	1477893600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE S DE GUZMAN

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	818-763-8836
Fax Number	:

Provider Business Practice Location Address
First Line	:	6225 SMITH AVE STE B300
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-3613
Country	:	US
Telephone Number	:	410-583-2653
Fax Number	:

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

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	07/07/2025

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Directions to “ KATHERINE S DE GUZMAN ” Practice Location

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