Healthcare Provider Details

I. General information

NPI: 1699186130
Provider Name (Legal Business Name): ANN-THERESE GUILLORY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7329 BALMER ST BLDG 546
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

1217 E 2675 N
LAYTON UT
84040-8521
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-0634
  • Fax:
Mailing address:
  • Phone: 504-439-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number60072383102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: