Healthcare Provider Details

I. General information

NPI: 1750439303
Provider Name (Legal Business Name): KATHY MAE GUY-VANGUILDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SUMMER ST
LEOMINSTER MA
01453-3228
US

IV. Provider business mailing address

27 BLAKEVILLE RD
RINDGE NH
03461-5100
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-3372
  • Fax:
Mailing address:
  • Phone: 603-899-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number107045
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: