Provider Demographics
NPI:1851014757
Name:GUERRA, KATHERINE DORALYN (LPN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DORALYN
Last Name:GUERRA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EDWARD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5512
Mailing Address - Country:US
Mailing Address - Phone:914-882-2604
Mailing Address - Fax:
Practice Address - Street 1:20 EDWARD ST APT 1
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5512
Practice Address - Country:US
Practice Address - Phone:914-882-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344828-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse