Provider Demographics
NPI:1790960789
Name:GUILLORY, STEPHANIE SAIZAN (ANP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SAIZAN
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-5864
Practice Address - Street 1:1233 WAYNE GILMORE CIR
Practice Address - Street 2:SUITE 450
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6405
Practice Address - Country:US
Practice Address - Phone:337-942-3006
Practice Address - Fax:337-942-7744
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN087931-AP05435363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1039586Medicaid
LA3A6066833Medicare PIN