Provider Demographics
NPI:1285495192
Name:GUILLAUME, NADEGE (LPN)
Entity type:Individual
Prefix:MS
First Name:NADEGE
Middle Name:
Last Name:GUILLAUME
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:NADEGE
Other - Middle Name:
Other - Last Name:GUILLAUME-TODD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PRES MED PRO HEALTH
Mailing Address - Street 1:6644 EMERALD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4916
Mailing Address - Country:US
Mailing Address - Phone:954-292-9529
Mailing Address - Fax:954-919-9051
Practice Address - Street 1:6644 EMERALD LAKE DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4916
Practice Address - Country:US
Practice Address - Phone:954-292-9529
Practice Address - Fax:954-919-9051
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1192781164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse