Provider Demographics
NPI:1427484666
Name:GUARDIOLA, ELLIE C (BSN RN)
Entity type:Individual
Prefix:MS
First Name:ELLIE
Middle Name:C
Last Name:GUARDIOLA
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E NORTHERN AVE
Mailing Address - Street 2:#2017
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4161
Mailing Address - Country:US
Mailing Address - Phone:480-484-8711
Mailing Address - Fax:
Practice Address - Street 1:8801 N 56TH ST
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-2246
Practice Address - Country:US
Practice Address - Phone:480-484-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174479163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool