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NPI Code Detail

MEDICARE: MRS. GEORGETTE BOUDREAUX GUILLORY RN MSN CNS FNP-C

MEDICARE: MRS. GEORGETTE BOUDREAUX GUILLORY RN MSN CNS FNP-C
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
1363LF0000XFamily Nurse PractitionerAP0474LA

General Provider Information

NPI Number : 1518951086
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GEORGETTE BOUDREAUX GUILLORY RN MSN CNS FNP-C
Provider Business Mailing Address
First Line : 376 MAIN ST
Second Line :
City : CANKTON
State : LA
Zip : 70584
Country : US
Telephone Number : 337-668-4141
Fax Number : 337-668-4386
Provider Business Practice Location Address
First Line : 376 MAIN ST
Second Line :
City : CANKTON
State : LA
Zip : 70584
Country : US
Telephone Number : 337-668-4141
Fax Number : 337-668-4386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2005
Last Update Date : 06/30/2008

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