Provider Demographics
NPI:1619157591
Name:GUELL, MARY ANN (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:GUELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 17930
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72222-7930
Mailing Address - Country:US
Mailing Address - Phone:501-663-0490
Mailing Address - Fax:501-663-5948
Practice Address - Street 1:2 LILE CT
Practice Address - Street 2:SUITE 102B
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6221
Practice Address - Country:US
Practice Address - Phone:501-663-0490
Practice Address - Fax:501-663-5948
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARP01637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199556758Medicaid
AR5X842Medicare PIN
ARQ12140Medicare UPIN