Provider Demographics
NPI:1124717095
Name:GUEGAN, SUSAN SCHILIRO (NC, CHC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:SCHILIRO
Last Name:GUEGAN
Suffix:
Gender:F
Credentials:NC, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3882 WONDERLAND HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1036
Mailing Address - Country:US
Mailing Address - Phone:720-480-4266
Mailing Address - Fax:
Practice Address - Street 1:3882 WONDERLAND HILL AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1036
Practice Address - Country:US
Practice Address - Phone:720-480-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education