Provider Demographics
NPI:1497017164
Name:GUERRA, ROXANA (RN BSN)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 59TH AVE APT 1K
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5122
Mailing Address - Country:US
Mailing Address - Phone:917-645-7336
Mailing Address - Fax:
Practice Address - Street 1:9410 59TH AVE APT 1K
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5122
Practice Address - Country:US
Practice Address - Phone:917-645-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY655634163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator