Provider Demographics
NPI:1952905804
Name:GUARRACINO, ALYSSA LYNN
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYNN
Last Name:GUARRACINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DOMENICA RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2706
Mailing Address - Country:US
Mailing Address - Phone:781-831-1740
Mailing Address - Fax:
Practice Address - Street 1:1 DOMENICA RD
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2706
Practice Address - Country:US
Practice Address - Phone:781-831-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308557163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine