Provider Demographics
NPI:1497280291
Name:RESERVA, GUINEVERE B (AMT)
Entity Type:Individual
Prefix:
First Name:GUINEVERE
Middle Name:B
Last Name:RESERVA
Suffix:
Gender:F
Credentials:AMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SAWMILL CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62563-6057
Mailing Address - Country:US
Mailing Address - Phone:217-502-0419
Mailing Address - Fax:
Practice Address - Street 1:515 SAWMILL CT
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-6057
Practice Address - Country:US
Practice Address - Phone:217-502-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-29
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist