Provider Demographics
NPI:1750665717
Name:GUZMAN, NIECHELLE CHRISTINE (LAC)
Entity Type:Individual
Prefix:
First Name:NIECHELLE
Middle Name:CHRISTINE
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 OLYMPIA WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3929
Mailing Address - Country:US
Mailing Address - Phone:360-577-8989
Mailing Address - Fax:360-577-8985
Practice Address - Street 1:1717 OLYMPIA WAY STE 104
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3929
Practice Address - Country:US
Practice Address - Phone:360-577-8989
Practice Address - Fax:360-577-8985
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60246519171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist