Provider Demographics
NPI:1366963506
Name:GUYETTE, EMILIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:EMILIA
Middle Name:
Last Name:GUYETTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-1831
Mailing Address - Country:US
Mailing Address - Phone:315-276-0044
Mailing Address - Fax:
Practice Address - Street 1:12 CENTER CIR
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-1831
Practice Address - Country:US
Practice Address - Phone:315-276-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237744-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty