Provider Demographics
NPI:1831723881
Name:GUILMAIN, PETRA LAURA
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:LAURA
Last Name:GUILMAIN
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:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-0328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4535 SOUTHWESTERN BLVD BLDG SUITE704
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1860
Practice Address - Country:US
Practice Address - Phone:716-689-3333
Practice Address - Fax:716-689-9695
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402900363LP0808X
NYF402900-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health