Provider Demographics
NPI:1437374675
Name:GUTEKUNST, TANIA MARIE (CNA)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:MARIE
Last Name:GUTEKUNST
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 GUILFORD ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-3855
Mailing Address - Country:US
Mailing Address - Phone:717-813-7382
Mailing Address - Fax:
Practice Address - Street 1:218 GUILFORD ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-3855
Practice Address - Country:US
Practice Address - Phone:717-813-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4920052376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide