Provider Demographics
NPI:1265784250
Name:GUILLAUME, NATHALIE (DAOM, LAC)
Entity type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:
Last Name:GUILLAUME
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WEST 26TH STREET
Mailing Address - Street 2:SUITE 903
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-206-7516
Mailing Address - Fax:
Practice Address - Street 1:134 WEST 26TH STREET
Practice Address - Street 2:SUITE 903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-206-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004919171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004919OtherNEW YORK LICENSE