Provider Demographics
NPI:1881661817
Name:GUIDA, MANON (APRN)
Entity Type:Individual
Prefix:MISS
First Name:MANON
Middle Name:
Last Name:GUIDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:622 HEBRON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2421
Mailing Address - Country:US
Mailing Address - Phone:860-657-3376
Mailing Address - Fax:860-633-7712
Practice Address - Street 1:622 HEBRON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2421
Practice Address - Country:US
Practice Address - Phone:860-657-3376
Practice Address - Fax:860-633-7712
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002062163WU0100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WU0100XNursing Service ProvidersRegistered NurseUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS86933Medicare UPIN