Provider Demographics
NPI:1982712709
Name:GUERCIO, MATTHEW P (CRNA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:GUERCIO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 FT UNION BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6800
Mailing Address - Country:US
Mailing Address - Phone:801-993-9527
Mailing Address - Fax:801-733-5618
Practice Address - Street 1:1200 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1300
Practice Address - Country:US
Practice Address - Phone:801-261-8272
Practice Address - Fax:801-261-8389
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT368932-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT36893244001001OtherREGENCE BCBS
UT198946OtherALTIUS
UTP00668627OtherRAILROAD MCR
UT870474993017/D6539Medicaid
UT36893244001001OtherREGENCE BCBS
UT005582347Medicare ID - Type Unspecified