MEDICARE: MR. STEPHEN W GUILLOT NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	742522	TX
2	363LC0200X	Critical Care Medicine Nurse Practitioner	742522	TX

General Provider Information

NPI Number	:	1205348919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN W GUILLOT NP

Provider Business Mailing Address
First Line	:	16851 RIO RED
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-2625
Country	:	US
Telephone Number	:	956-505-1035
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 S UTAH AVE STE C
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78596-5588
Country	:	US
Telephone Number	:	956-376-2325
Fax Number	:	956-376-2326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2017
Last Update Date	:	05/09/2024

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