Provider Demographics
NPI:1497381453
Name:GUIDRY, CARRIE ELAINE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELAINE
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 N PERSHING AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6955
Mailing Address - Country:US
Mailing Address - Phone:209-641-2881
Mailing Address - Fax:
Practice Address - Street 1:4415 N PERSHING AVE APT 4
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6955
Practice Address - Country:US
Practice Address - Phone:209-641-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program