Basic Information
| Provider Information | |||||||||
| NPI: | 1881661817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUIDA | ||||||||
| FirstName: | MANON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 HEBRON AVE | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060332421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606573376 | ||||||||
| FaxNumber: | 8606337712 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 HEBRON AVE | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060332421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606573376 | ||||||||
| FaxNumber: | 8606337712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WU0100X | 002062 | CT | N | Nursing Service Providers | Registered Nurse | Urology | 363L00000X | 002062 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.