Provider Demographics
NPI:1952899981
Name:ENAMORADO, GUADALUPE VANESSA (RN)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:VANESSA
Last Name:ENAMORADO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 S EWING AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-5221
Mailing Address - Country:US
Mailing Address - Phone:469-237-0144
Mailing Address - Fax:
Practice Address - Street 1:3314 S EWING AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5221
Practice Address - Country:US
Practice Address - Phone:469-237-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX939778163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse