Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP8838 | AZ |
NPI | 1023461746 |
---|---|
Provider Name | Jole-Lanee Guido |
First Address | Gilbert, AZ 85295-2152 |
Second Address | Gilbert, AZ 85295-2152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2016 |
Last Update Date | 27/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
167649 | (05) | AZ |