Provider Demographics
NPI:1386967008
Name:MINKIEWICZ GUGLIUZZA, SUSAN (RNC, MS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MINKIEWICZ GUGLIUZZA
Suffix:
Gender:F
Credentials:RNC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 WILLOWBROOK DR W
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1488
Mailing Address - Country:US
Mailing Address - Phone:716-741-0177
Mailing Address - Fax:716-741-0177
Practice Address - Street 1:5105 WILLOWBROOK DR W
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1488
Practice Address - Country:US
Practice Address - Phone:716-741-0177
Practice Address - Fax:716-741-0177
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY391419-1163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support