Healthcare Provider Details

I. General information

NPI: 1477103067
Provider Name (Legal Business Name): KATELYN GUZMAN DNP, CNM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 GRELLE AVE
LEWISTON ID
83501-5262
US

IV. Provider business mailing address

1322 MILL CREEK BLVD APT S105
MILL CREEK WA
98012-4026
US

V. Phone/Fax

Practice location:
  • Phone: 208-631-9140
  • Fax:
Mailing address:
  • Phone: 208-631-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number236473
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN60968916
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: