Provider Demographics
NPI:1942854559
Name:GUILLEN, KARI COLLINS (LAC)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:COLLINS
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:NICOLE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:MOUNT DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660-0048
Mailing Address - Country:US
Mailing Address - Phone:207-401-2242
Mailing Address - Fax:
Practice Address - Street 1:54 HERRICK RD
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4431
Practice Address - Country:US
Practice Address - Phone:207-401-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC628171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist