Healthcare Provider Details

I. General information

NPI: 1619378148
Provider Name (Legal Business Name): LISA MARIE GUZMAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 GAUSE BLVD E
SLIDELL LA
70461-4149
US

IV. Provider business mailing address

2750 GAUSE BLVD E
SLIDELL LA
70461-4149
US

V. Phone/Fax

Practice location:
  • Phone: 985-639-3777
  • Fax:
Mailing address:
  • Phone: 985-639-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08029
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: