Provider Demographics
NPI:1336792738
Name:GUIAB, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:GUIAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8042 KENTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3180
Mailing Address - Country:US
Mailing Address - Phone:847-431-1019
Mailing Address - Fax:
Practice Address - Street 1:8042 KENTON AVE APT 2
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3180
Practice Address - Country:US
Practice Address - Phone:847-431-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner