1740295211 NPI number — MS. REBECCA GUEVARA MCKERNAN CNS, APN

Table of content: MS. REBECCA GUEVARA MCKERNAN CNS, APN (NPI 1740295211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740295211 NPI number — MS. REBECCA GUEVARA MCKERNAN CNS, APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKERNAN
Provider First Name:
REBECCA
Provider Middle Name:
GUEVARA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNS, APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740295211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
933 BRADBURY DR SE
Provider Second Line Business Mailing Address:
SUITE 2222
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87106-4374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-3120
Provider Business Mailing Address Fax Number:
505-272-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7801 ACADEMY RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-3379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-2290
Provider Business Practice Location Address Fax Number:
505-272-8982
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  R17858 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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