1225695752 NPI number — MR. ROGER GUERIN FNP

Table of content: MR. ROGER GUERIN FNP (NPI 1225695752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225695752 NPI number — MR. ROGER GUERIN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERIN
Provider First Name:
ROGER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225695752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 894
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ROADS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70760-0894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-718-8351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RIVER PLACE BEHAVIORAL HOSPITAL
Provider Second Line Business Practice Location Address:
500 RUE DE SANTE RD.
Provider Business Practice Location Address City Name:
LAPLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-444-5151
Provider Business Practice Location Address Fax Number:
985-444-5117
Provider Enumeration Date:
05/21/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  200857 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)