Provider Demographics
NPI:1346725934
Name:NIETO, GUADALUPE LAREDO
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:LAREDO
Last Name:NIETO
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 1:3244 E GLEN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1902
Mailing Address - Country:US
Mailing Address - Phone:915-202-1646
Mailing Address - Fax:
Practice Address - Street 1:3244 E GLEN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1902
Practice Address - Country:US
Practice Address - Phone:915-202-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215537164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse