MEDICARE: GUILIOUSE LIMPREVIL

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	164W00000X	Licensed Practical Nurse	305387	NY

General Provider Information

NPI Number	:	1891216818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUILIOUSE LIMPREVIL

Provider Business Mailing Address
First Line	:	848 HARBOR CIR
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-4036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 HARBOR CIR
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-4036
Country	:	US
Telephone Number	:	917-385-2547
Fax Number	:

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

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	06/29/2017

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Directions to “ GUILIOUSE LIMPREVIL ” Practice Location

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