Healthcare Provider Details

I. General information

NPI: 1902283161
Provider Name (Legal Business Name): STEPHANIE GUINOTTE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE GUINOTTE NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E LOGAN ST
OTTAWA KS
66067-2056
US

IV. Provider business mailing address

3118 W 19TH ST
LAWRENCE KS
66047-2200
US

V. Phone/Fax

Practice location:
  • Phone: 785-242-2067
  • Fax: 785-242-2068
Mailing address:
  • Phone: 785-760-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5345772071
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: