Provider Demographics
NPI:1972575058
Name:GUERRINA, MARY LOU (NP)
Entity Type:Individual
Prefix:
First Name:MARY LOU
Middle Name:
Last Name:GUERRINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14450 SMOKETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4712
Mailing Address - Country:US
Mailing Address - Phone:703-491-7668
Mailing Address - Fax:
Practice Address - Street 1:14450 SMOKETOWN RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4712
Practice Address - Country:US
Practice Address - Phone:703-491-7668
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024054405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health