Provider Demographics
NPI:1205134269
Name:GUZMAN, CARMEN EMILIA (NURSE LPN)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:EMILIA
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:NURSE LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4062
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-4062
Mailing Address - Country:US
Mailing Address - Phone:732-233-1307
Mailing Address - Fax:732-870-0271
Practice Address - Street 1:28 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5807
Practice Address - Country:US
Practice Address - Phone:732-233-1397
Practice Address - Fax:732-870-0271
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP04315800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse