Provider Demographics
NPI:1801516596
Name:GUERRERO, ANDREA LANE (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LANE
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 TRACY CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-3779
Mailing Address - Country:US
Mailing Address - Phone:920-213-7498
Mailing Address - Fax:
Practice Address - Street 1:27 TRACY CT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3779
Practice Address - Country:US
Practice Address - Phone:920-213-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189506-30163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult