Provider Demographics
NPI:1790344018
Name:NGUEMEGNI, GUYSELA YOUBI (NP)
Entity Type:Individual
Prefix:
First Name:GUYSELA
Middle Name:YOUBI
Last Name:NGUEMEGNI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8601
Mailing Address - Country:US
Mailing Address - Phone:815-356-0386
Mailing Address - Fax:
Practice Address - Street 1:5901 N CICERO AVE STE 207
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5718
Practice Address - Country:US
Practice Address - Phone:331-425-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019616363LF0000X
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program