Provider Demographics
NPI:1124129960
Name:GUEST, MARY ANGELA (RN, MSN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELA
Last Name:GUEST
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S FLOYD ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1835
Mailing Address - Country:US
Mailing Address - Phone:502-852-0136
Mailing Address - Fax:502-852-0135
Practice Address - Street 1:601 S FLOYD ST
Practice Address - Street 2:SUITE 801
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1835
Practice Address - Country:US
Practice Address - Phone:502-852-0136
Practice Address - Fax:502-852-0135
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1057088163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics