Provider Demographics
NPI:1649782012
Name:GUO, FENG (FNP-C)
Entity type:Individual
Prefix:
First Name:FENG
Middle Name:
Last Name:GUO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 HAGEN DR N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4555
Mailing Address - Country:US
Mailing Address - Phone:917-880-2320
Mailing Address - Fax:
Practice Address - Street 1:7200 VALLEY CREEK PLZ
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2265
Practice Address - Country:US
Practice Address - Phone:651-735-9517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily