Provider Demographics
NPI:1689828261
Name:GUERRA, ANGELA (LAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 S 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3112
Mailing Address - Country:US
Mailing Address - Phone:262-685-7661
Mailing Address - Fax:262-334-4078
Practice Address - Street 1:705 VILLAGE GREEN WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-2527
Practice Address - Country:US
Practice Address - Phone:262-685-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI537-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist