Provider Demographics
NPI:1235661570
Name:MICHAUD-MESIDOR, GUILAINE
Entity Type:Individual
Prefix:
First Name:GUILAINE
Middle Name:
Last Name:MICHAUD-MESIDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GUILAINE
Other - Middle Name:
Other - Last Name:MICHAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:896 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7917
Mailing Address - Country:US
Mailing Address - Phone:239-398-5469
Mailing Address - Fax:
Practice Address - Street 1:896 GALLOPING HILL RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7917
Practice Address - Country:US
Practice Address - Phone:929-278-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00717000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily