Provider Demographics
NPI:1275949323
Name:GUADALUPE-ANDERSEN, KIMBERLY M (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:GUADALUPE-ANDERSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CALLE 535 APT 527
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-2306
Mailing Address - Country:US
Mailing Address - Phone:787-750-7655
Mailing Address - Fax:
Practice Address - Street 1:1357 AVE ASHFORD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1420
Practice Address - Country:US
Practice Address - Phone:787-721-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1972367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered