Provider Demographics
NPI:1588198709
Name:GUERRERO, MIA MARISSA (NNP)
Entity Type:Individual
Prefix:MRS
First Name:MIA
Middle Name:MARISSA
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:MARISSA
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1900 N OREGON ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3351
Mailing Address - Country:US
Mailing Address - Phone:915-542-0755
Mailing Address - Fax:
Practice Address - Street 1:1900 N OREGON ST
Practice Address - Street 2:SUITE 601
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3351
Practice Address - Country:US
Practice Address - Phone:915-542-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133643364SN0000X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal