Basic Information
| Provider Information | |||||||||
| NPI: | 1740509009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOUIS | ||||||||
| FirstName: | GUERLANDE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139054246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077985111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 169 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139054246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077985111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2010 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 014003 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207PE0004X | 014033 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.