Provider Demographics
NPI:1326023201
Name:GUILLOT, MARY LOU (CRNA,FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY LOU
Middle Name:
Last Name:GUILLOT
Suffix:
Gender:F
Credentials:CRNA,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0395
Mailing Address - Country:US
Mailing Address - Phone:225-683-5292
Mailing Address - Fax:225-683-3411
Practice Address - Street 1:11990 JACKSON ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-3210
Practice Address - Country:US
Practice Address - Phone:225-683-5292
Practice Address - Fax:225-683-3411
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRNA00994367500000X
LA1395994367500000X
LAAP01331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08309838Medicaid
LA1395994OtherCRNA
MS08309838OtherCRNA/FNP
LA1445894OtherFNP-C
LA1189405Medicaid
MS430002024Medicare ID - Type UnspecifiedCRNA
LA4C975Medicare PIN
MS08309838OtherCRNA/FNP
LA4C975CH71Medicare PIN