MEDICARE: PAMELA SUE GUERRERO

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	231H00000X	Audiologist	3501003116	MI

General Provider Information

NPI Number	:	1871800508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA SUE GUERRERO

Provider Business Mailing Address
First Line	:	PO BOX 406153
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-1876
Country	:	US
Telephone Number	:	561-478-8770
Fax Number	:	561-598-7231

Provider Business Practice Location Address
First Line	:	3175 CHRISTY WAY S
Second Line	:	SUITE 4
City	:	SAGINAW
State	:	MI
Zip	:	48603-2210
Country	:	US
Telephone Number	:	989-799-1611
Fax Number	:	989-799-1622

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	09/01/2010

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Directions to “ PAMELA SUE GUERRERO ” Practice Location

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