Healthcare Provider Details

I. General information

NPI: 1700316601
Provider Name (Legal Business Name): CARRIE ALICE GUILFOYLE ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BRANSCOMB ROAD
LAYTONVILLE CA
95454
US

IV. Provider business mailing address

50 BRANSCOMB ROAD LONG VALLEY HEALTH CENTER
LAYTONVILLE CA
95454
US

V. Phone/Fax

Practice location:
  • Phone: 707-984-6131
  • Fax:
Mailing address:
  • Phone: 707-984-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG02170177
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: