Provider Demographics
NPI:1932783875
Name:67 ON TRADD LLC
Entity type:Organization
Organization Name:67 ON TRADD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERARD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:251-213-3066
Mailing Address - Street 1:12 RIDGECLIFF CT
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 RIDGECLIFF CT
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21087-1253
Practice Address - Country:US
Practice Address - Phone:251-213-3066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty