Provider Demographics
NPI:1245899228
Name:GUERECA, AUDRA
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:GUERECA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:KAY
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2743
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-2743
Mailing Address - Country:US
Mailing Address - Phone:817-269-3084
Mailing Address - Fax:
Practice Address - Street 1:513 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-6371
Practice Address - Country:US
Practice Address - Phone:817-269-3084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant