Provider Demographics
NPI:1396720660
Name:MCGUIRE, ALICE (PMHNP)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:PMHNP
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 3590
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3590
Mailing Address - Country:US
Mailing Address - Phone:361-729-5357
Mailing Address - Fax:361-576-4219
Practice Address - Street 1:101 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-2748
Practice Address - Country:US
Practice Address - Phone:361-729-5357
Practice Address - Fax:361-576-4219
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537591363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP8030OtherBCBS OF TX #
TXNP8030OtherBCBS OF TX #
TX609924Medicare ID - Type Unspecified