Provider Demographics
NPI:1184843872
Name:GUYTON, LATRIESE (RN)
Entity type:Individual
Prefix:MRS
First Name:LATRIESE
Middle Name:
Last Name:GUYTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12723 HONORE ST
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2205
Mailing Address - Country:US
Mailing Address - Phone:708-489-5798
Mailing Address - Fax:
Practice Address - Street 1:12723 HONORE ST
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2205
Practice Address - Country:US
Practice Address - Phone:708-489-5798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support