MEDICARE: MRS. SABRINA GUILLORY CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	10423	TX

General Provider Information

NPI Number	:	1104821180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SABRINA GUILLORY CNM

Provider Business Mailing Address
First Line	:	1204 N MOUND ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75961-4027
Country	:	US
Telephone Number	:	936-569-4101
Fax Number	:	936-569-4174

Provider Business Practice Location Address
First Line	:	1204 N MOUND ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75961-4027
Country	:	US
Telephone Number	:	936-569-4101
Fax Number	:	936-569-4174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/31/2012

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