MEDICARE: MRS. SHAWNTAE AKILA GUERRIER HS1

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	246Y00000X	Health Information Specialist/Technologist
2	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1669555686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAWNTAE AKILA GUERRIER HS1

Provider Business Mailing Address
First Line	:	4605 PATRICK HENRY CIR UNIT A
Second Line	:
City	:	SCOTT AFB
State	:	IL
Zip	:	62225-6206
Country	:	US
Telephone Number	:	305-721-7675
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 SPRUCE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2818
Country	:	US
Telephone Number	:	314-269-2374
Fax Number	:

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	04/22/2024

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