1326023201 NPI number — MRS. MARY LOU GUILLOT CRNA,FNP-C

Table of content: MRS. MARY LOU GUILLOT CRNA,FNP-C (NPI 1326023201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326023201 NPI number — MRS. MARY LOU GUILLOT CRNA,FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUILLOT
Provider First Name:
MARY LOU
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA,FNP-C
Provider Gender Code:
F

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:
1326023201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 395
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70722-0395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-683-5292
Provider Business Mailing Address Fax Number:
225-683-3411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11990 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70722-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-683-5292
Provider Business Practice Location Address Fax Number:
225-683-3411
Provider Enumeration Date:
12/13/2005

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: 367500000X , with the licence number:  CRNA00994 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 1395994 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP01331 , 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)

  • Identifier: 08309838 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1395994 . This is a "CRNA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 08309838 . This is a "CRNA/FNP" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1445894 . This is a "FNP-C" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1189405 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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