Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN078829NP | GA |
NPI | 1548256233 |
---|---|
Provider Name | Rene Guild |
First Address | Blue Ridge, GA 30513-4431 |
Second Address | Blue Ridge, GA 30513-4431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000843785H | (05) | GA |
202I503048 | MEDICARE PTAN (01) | GA |
GRP 1855 | MEDICARE GROUP PTAN (01) | |
MG2284355 | DEA REGISTRATION (01) | GA |
RN078829NP | NURSE PRACTITIONER LIC. (01) | GA |