Provider Demographics
NPI:1780163899
Name:GUICE, SANDRA (RN, BSN, MAOM)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GUICE
Suffix:
Gender:F
Credentials:RN, BSN, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LAYTON AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-8548
Mailing Address - Country:US
Mailing Address - Phone:318-807-0206
Mailing Address - Fax:
Practice Address - Street 1:210 LAYTON AVE STE 10
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8548
Practice Address - Country:US
Practice Address - Phone:318-807-0206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN081265163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse