Provider Demographics
NPI:1245758515
Name:GUFFEY, VIDA M (RN)
Entity Type:Individual
Prefix:
First Name:VIDA
Middle Name:M
Last Name:GUFFEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VIDA
Other - Middle Name:M
Other - Last Name:LONGORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:607 E APACHE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6925
Mailing Address - Country:US
Mailing Address - Phone:505-326-2012
Mailing Address - Fax:505-326-2939
Practice Address - Street 1:607 E APACHE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6925
Practice Address - Country:US
Practice Address - Phone:505-326-2012
Practice Address - Fax:505-326-2012
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR22764163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse