Provider Demographics
NPI:1346770914
Name:GUIAB, MARK NORBERT PRECIADO (FPA, PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARK NORBERT
Middle Name:PRECIADO
Last Name:GUIAB
Suffix:
Gender:M
Credentials:FPA, PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4215 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-6479
Mailing Address - Country:US
Mailing Address - Phone:815-988-8500
Mailing Address - Fax:815-977-5956
Practice Address - Street 1:4215 NEWBURG RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-6479
Practice Address - Country:US
Practice Address - Phone:815-988-8500
Practice Address - Fax:815-977-5956
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016243363L00000X
IL277001928363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner