Provider Demographics
NPI:1477103067
Name:GUZMAN, KATELYN (DNP, CNM, RN)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:DNP, CNM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 MILL CREEK BLVD APT S105
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4026
Mailing Address - Country:US
Mailing Address - Phone:208-631-9140
Mailing Address - Fax:
Practice Address - Street 1:1418 GRELLE AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5262
Practice Address - Country:US
Practice Address - Phone:208-631-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236473176B00000X
WARN60968916163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No176B00000XOther Service ProvidersMidwife