Provider Demographics
NPI:1306847611
Name:GUTHRIE, NANCYANN PAWLIK (MD)
Entity Type:Individual
Prefix:
First Name:NANCYANN
Middle Name:PAWLIK
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:PAWLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:437 MARSH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3822
Mailing Address - Country:US
Mailing Address - Phone:805-783-7044
Mailing Address - Fax:805-783-7047
Practice Address - Street 1:437 MARSH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3822
Practice Address - Country:US
Practice Address - Phone:805-783-7044
Practice Address - Fax:805-783-7047
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54852208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G548520Medicaid
CA00G548520Medicaid
CA00G548520Medicaid