MEDICARE: MARY GUIMOND CRNP

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	363LW0102X	Women's Health Nurse Practitioner	SP011500	PA

General Provider Information

NPI Number	:	1871832154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GUIMOND CRNP

Provider Business Mailing Address
First Line	:	600 FORBES AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15219-3016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 FORBES AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15219-3016
Country	:	US
Telephone Number	:	412-396-1653
Fax Number	:

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

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

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