Provider Demographics
NPI:1740065754
Name:GUILLEN, EDELAINE G (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:EDELAINE
Middle Name:G
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 SIENA HEIGHTS DR STE 140
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4168
Mailing Address - Country:US
Mailing Address - Phone:725-780-1973
Mailing Address - Fax:
Practice Address - Street 1:2865 SIENA HEIGHTS DR STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4168
Practice Address - Country:US
Practice Address - Phone:725-780-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV867403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily