Provider Demographics
NPI:1194506469
Name:ERICKSON, GUYLAINE (LPN)
Entity type:Individual
Prefix:
First Name:GUYLAINE
Middle Name:
Last Name:ERICKSON
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:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:AQUEBOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11931-0323
Mailing Address - Country:US
Mailing Address - Phone:631-513-2929
Mailing Address - Fax:
Practice Address - Street 1:4 SOUTHFIELDS RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1725
Practice Address - Country:US
Practice Address - Phone:631-513-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170896-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse