Provider Demographics
NPI:1427446996
Name:GUANDIQUE, ANGELA (CNA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GUANDIQUE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 TRELLIS DR
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-7571
Mailing Address - Country:US
Mailing Address - Phone:775-302-3593
Mailing Address - Fax:
Practice Address - Street 1:434 TRELLIS DR
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-7571
Practice Address - Country:US
Practice Address - Phone:775-302-3593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNA031027376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00001791413Medicaid