Provider Demographics
NPI:1417190992
Name:GUILLERMO, ERICA M (NP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:M
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 VALHI BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5974
Mailing Address - Country:US
Mailing Address - Phone:985-223-3871
Mailing Address - Fax:985-223-8779
Practice Address - Street 1:578 VALHI BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5974
Practice Address - Country:US
Practice Address - Phone:985-223-3871
Practice Address - Fax:985-223-8779
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN111374363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner