Provider Demographics
NPI:1659842003
Name:GUEDJE, MYRIANTE MANEFOUET
Entity Type:Individual
Prefix:MRS
First Name:MYRIANTE
Middle Name:MANEFOUET
Last Name:GUEDJE
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 1:615 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4325
Mailing Address - Country:US
Mailing Address - Phone:678-927-0685
Mailing Address - Fax:
Practice Address - Street 1:615 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4325
Practice Address - Country:US
Practice Address - Phone:678-927-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN252624163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator