Basic Information
Provider Information
NPI: 1205990660
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUYETTE
FirstName: JANEL
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6 CENTERPOINTE DRIVE
Address2: STE 200
City: LAKE OSWEGO
State: OR
PostalCode: 97035
CountryCode: US
TelephoneNumber: 5037972250
FaxNumber: 5039140335
Practice Location
Address1: 6445 N GREELEY AVENUE
Address2:  
City: PORTLAND
State: OR
PostalCode: 97217
CountryCode: US
TelephoneNumber: 5032856607
FaxNumber: 5032853195
Other Information
ProviderEnumerationDate: 12/20/2006
LastUpdateDate: 10/28/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD27138ORY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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