MEDICARE: GUERLINE PAUL DEJEAN N.P.

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	363LA2200X	Adult Health Nurse Practitioner	610758	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	610758	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538141361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUERLINE PAUL DEJEAN N.P.

Provider Business Mailing Address
First Line	:	2656 S LOOP W
Second Line	:	STE 103
City	:	HOUSTON
State	:	TX
Zip	:	77054-5632
Country	:	US
Telephone Number	:	832-265-6522
Fax Number	:	713-349-9887

Provider Business Practice Location Address
First Line	:	2656 S LOOP W
Second Line	:	STE 103
City	:	HOUSTON
State	:	TX
Zip	:	77054-5632
Country	:	US
Telephone Number	:	713-728-6734
Fax Number	:	713-728-6735

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	06/16/2018

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