Provider Demographics
NPI:1114451879
Name:GUEVARA, EDITHA (CNP)
Entity Type:Individual
Prefix:
First Name:EDITHA
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:EDITHA
Other - Middle Name:
Other - Last Name:ROME GUEVARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 844596
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4596
Mailing Address - Country:US
Mailing Address - Phone:440-879-0081
Mailing Address - Fax:
Practice Address - Street 1:1100 ALLIED DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5348
Practice Address - Country:US
Practice Address - Phone:877-814-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132349363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care