Healthcare Provider Details

I. General information

NPI: 1699424523
Provider Name (Legal Business Name): MICHELLE SANDLIN GUIDRY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 N CANAL BLVD
THIBODAUX LA
70301-8095
US

IV. Provider business mailing address

931 N CANAL BLVD
THIBODAUX LA
70301-8095
US

V. Phone/Fax

Practice location:
  • Phone: 985-446-6381
  • Fax:
Mailing address:
  • Phone: 985-446-6381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number224446
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number224446
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: