Provider Demographics
NPI:1871655217
Name:GUILLERMO, CHRISTINE MARIE (MHS PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:MHS PA-C
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:HELLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1818
Mailing Address - Country:US
Mailing Address - Phone:405-632-6688
Mailing Address - Fax:844-689-9671
Practice Address - Street 1:4021 S WALKER AVE STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-6977
Practice Address - Country:US
Practice Address - Phone:405-246-3950
Practice Address - Fax:844-689-9671
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1439207P00000X, 363A00000X
CO2215363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200071440AMedicaid
OKOK100337Medicare PIN
OK200071440AMedicaid