Provider Demographics
NPI:1679028302
Name:GUERRERO, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:GUERRERO
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 1:2605 E ALPINE LAKE DR
Mailing Address - Street 2:APT G
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-6338
Mailing Address - Country:US
Mailing Address - Phone:517-499-7576
Mailing Address - Fax:
Practice Address - Street 1:2605 E ALPINE LAKE DR
Practice Address - Street 2:APT G
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-6338
Practice Address - Country:US
Practice Address - Phone:517-499-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other