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Stefani Viviane Guerrero

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

16817 Marvin Rd, Charlotte, NC 28277-2196

PECOS Enrollment

This provider is enrolled in PECOS as STEFANI GUERRERO.

Based on the most recent information from CMS, provider Stefani Viviane Guerrero is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 34 days ago.

Profile Details

Provider ID
1861766701
Provider Type
Individual
Full Name
Guerrero, Stefani Viviane
Title
Mrs.
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
2/23/2012
Last Updated
1/24/2023

Contact Information

Practice Location

16817 Marvin Rd, Charlotte, NC 28277-2196

(704) 495-6036

Unlisted Fax

Mailing Location

5960 Fairview Rd Ste 500, Charlotte, NC 28210-3113

(704) 495-6334

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 0010-10802 North Carolina
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA9106437 Florida

Provider Identifiers

ID	Description	Issuer
ID 1861766701	Description Medicaid	Issuer Unlisted North Carolina

Stefani Viviane Guerrero

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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