Provider Demographics
NPI:1215549134
Name:MCGUIRE, KATRINA
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:WV
Mailing Address - Zip Code:25265-0122
Mailing Address - Country:US
Mailing Address - Phone:304-593-6173
Mailing Address - Fax:
Practice Address - Street 1:111 MILL ST LOT 3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:WV
Practice Address - Zip Code:25265-7704
Practice Address - Country:US
Practice Address - Phone:304-593-6173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant