Provider Demographics
NPI:1518951086
Name:GUILLORY, GEORGETTE BOUDREAUX (RN MSN CNS FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:GEORGETTE
Middle Name:BOUDREAUX
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:RN MSN CNS FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANKTON
Mailing Address - State:LA
Mailing Address - Zip Code:70584
Mailing Address - Country:US
Mailing Address - Phone:337-668-4141
Mailing Address - Fax:337-668-4386
Practice Address - Street 1:376 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANKTON
Practice Address - State:LA
Practice Address - Zip Code:70584
Practice Address - Country:US
Practice Address - Phone:337-668-4141
Practice Address - Fax:337-668-4386
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP0474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA193862Medicare Oscar/Certification
LAQ52392Medicare UPIN