Provider Demographics
NPI:1871886200
Name:GUADALUPE, MARIA LOUISE
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LOUISE
Last Name:GUADALUPE
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 1:604 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2479
Mailing Address - Country:US
Mailing Address - Phone:609-784-3992
Mailing Address - Fax:
Practice Address - Street 1:604 BLOOMFIELD DR
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-2479
Practice Address - Country:US
Practice Address - Phone:609-784-3992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06589100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NP06589100OtherLICENSE NUMBER