Provider Demographics
NPI:1689002990
Name:GUILLAUME, SARAH C (ANP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:C
Last Name:GUILLAUME
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 TESSON FERRY RD STE 45
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-4062
Mailing Address - Country:US
Mailing Address - Phone:314-748-5917
Mailing Address - Fax:314-748-5919
Practice Address - Street 1:13303 TESSON FERRY RD STE 45
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-4062
Practice Address - Country:US
Practice Address - Phone:314-748-5917
Practice Address - Fax:314-748-5919
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013016316363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health