Basic Information
| Provider Information | |||||||||
| NPI: | 1821574369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUERRIERO | ||||||||
| FirstName: | KELCEY | ||||||||
| MiddleName: | GOODWIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14869 MCLAIN AVE | ||||||||
| Address2: | |||||||||
| City: | ALLEN PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481011816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136936076 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5500 AUTO CLUB DR | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006536568 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2018 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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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 | 363LP2300X | 4704277474 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363L00000X | 4704277474 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.