Provider Demographics
NPI:1124083407
Name:GUINIGUNDO, ANDREW S (CNP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:GUINIGUNDO
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5053 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2326
Mailing Address - Country:US
Mailing Address - Phone:513-751-2273
Mailing Address - Fax:513-751-2138
Practice Address - Street 1:4350 MALSBARY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5621
Practice Address - Country:US
Practice Address - Phone:513-751-2273
Practice Address - Fax:513-792-5844
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN260103163WX0200X
KY3003467363LA2200X
OH06512-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500019639OtherMEDICARE RAILROAD
OH2279289Medicaid
KY78006962Medicaid
OH500019634OtherMEDICARE RAILROAD
IN201132050Medicaid
KYK064540Medicare PIN
OHP29694Medicare UPIN
KY78006962Medicaid