Basic Information
Provider Information
NPI: 1700386935
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUERRERO
FirstName: BRIGETTE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5934 SILVER TRACE CT
Address2:  
City: HENDERSON
State: NV
PostalCode: 890114922
CountryCode: US
TelephoneNumber: 7027243335
FaxNumber:  
Practice Location
Address1: 160 E HORIZON DR STE A
Address2:  
City: HENDERSON
State: NV
PostalCode: 890157934
CountryCode: US
TelephoneNumber: 7026443600
FaxNumber: 7027195665
Other Information
ProviderEnumerationDate: 02/14/2018
LastUpdateDate: 02/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
372500000X NVN Nursing Service Related ProvidersChore Provider 
372600000X NVN Nursing Service Related ProvidersAdult Companion 
3747A0650X NVN Nursing Service Related ProvidersTechnicianAttendant Care Provider
376J00000X NVN Nursing Service Related ProvidersHomemaker 
3747P1801X NVY Nursing Service Related ProvidersTechnicianPersonal Care Attendant

No ID Information.


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