1104927409 NPI number — LORENA GUERRERO FNP

Table of content: MS. SHERIKA ANN VANHARN (NPI 1558841866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104927409 NPI number — LORENA GUERRERO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERRERO
Provider First Name:
LORENA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1104927409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 E 67TH ST STE 119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98404-4223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-212-0202
Provider Business Mailing Address Fax Number:
253-212-0962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 E 67TH ST STE 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98404-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-212-0202
Provider Business Practice Location Address Fax Number:
253-212-0962
Provider Enumeration Date:
09/26/2006

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: 363L00000X , with the licence number:  AP60283194 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 601037 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP60283194 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 165561501 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 94393 . This is a "CARELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 165561501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2086163 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8N5077 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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