Provider Demographics
NPI:1699035246
Name:GUERIN, MARY M (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:GUERIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 E WARNER RD STE 109
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3417
Mailing Address - Country:US
Mailing Address - Phone:480-820-5525
Mailing Address - Fax:480-831-6755
Practice Address - Street 1:2033 E WARNER RD STE 109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284
Practice Address - Country:US
Practice Address - Phone:480-820-5525
Practice Address - Fax:480-831-6755
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF1111199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily