Provider Demographics
NPI:1144085184
Name:ESGUERRA, MARY JHENSSINE MAGALONG
Entity type:Individual
Prefix:MRS
First Name:MARY JHENSSINE
Middle Name:MAGALONG
Last Name:ESGUERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 RUCKERT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-1815
Mailing Address - Country:US
Mailing Address - Phone:314-473-4179
Mailing Address - Fax:
Practice Address - Street 1:2331 RUCKERT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-1815
Practice Address - Country:US
Practice Address - Phone:314-473-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023004805163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse