Provider Demographics
NPI:1659770915
Name:GUERRERO, WANDA S (APRN)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:S
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 E 71ST ST STE 305
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3922
Mailing Address - Country:US
Mailing Address - Phone:918-877-2618
Mailing Address - Fax:918-496-9010
Practice Address - Street 1:1831 E 71ST ST STE 305
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3922
Practice Address - Country:US
Practice Address - Phone:918-877-2618
Practice Address - Fax:918-496-9010
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0067681363LA2200X
OK67681363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health