Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 742522 | TX |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 742522 | TX |
NPI | 1205348919 |
---|---|
Provider Name | Mr. Stephen W Guillot |
First Address | Lafayette, LA 70508-3870 |
Second Address | Harlingen, TX 78550-8307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2017 |
Last Update Date | 06/08/2019 |