Provider Demographics
NPI:1023398401
Name:GUARNIERE, AMANDA JANE (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:GUARNIERE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JANE
Other - Last Name:LAMANNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:53 OLD STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1911
Mailing Address - Country:US
Mailing Address - Phone:401-301-2585
Mailing Address - Fax:
Practice Address - Street 1:6515 MAIN ST # 1A
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1354
Practice Address - Country:US
Practice Address - Phone:203-576-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307167363LA2200X, 363LA2200X
CT10649363LA2200X
OHCOA.12543-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04087674Medicaid
OH0065134Medicaid