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NPI Code Detail

MEDICARE: MRS. MYRANDA JAYDE GUERRERO

MEDICARE: MRS. MYRANDA JAYDE 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
1363LF0000XFamily Nurse PractitionerF05190115AL

General Provider Information

NPI Number : 1962068338
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MYRANDA JAYDE GUERRERO
Provider Business Mailing Address
First Line : 108 HEALEY DR
Second Line :
City : MADISON
State : AL
Zip : 35756-4073
Country : US
Telephone Number : 256-777-8295
Fax Number :
Provider Business Practice Location Address
First Line : 1222 SOMERVILLE RD SE
Second Line :
City : DECATUR
State : AL
Zip : 35601-4351
Country : US
Telephone Number : 256-341-0152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2019
Last Update Date : 05/04/2020

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