Provider Demographics
NPI:1487207866
Name:GUGGENMOS, CYNTHIA L
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:GUGGENMOS
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 1:43772 N PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NE
Mailing Address - Zip Code:68821-5122
Mailing Address - Country:US
Mailing Address - Phone:308-750-1643
Mailing Address - Fax:
Practice Address - Street 1:43772 N PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NE
Practice Address - Zip Code:68821-5122
Practice Address - Country:US
Practice Address - Phone:308-750-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112880363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care