Provider Demographics
NPI:1427476811
Name:GUICHELAAR, STEVEN (NP)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:GUICHELAAR
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5156
Mailing Address - Country:US
Mailing Address - Phone:317-902-8715
Mailing Address - Fax:
Practice Address - Street 1:556 WASHINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1149
Practice Address - Country:US
Practice Address - Phone:203-779-5799
Practice Address - Fax:203-599-0260
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28196369A163W00000X
VA0024189657363LP0808X
IN71004912A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201228430Medicaid
IN000000876664OtherANTHEM
IN000000876487OtherANTHEM
IN000000876664OtherANTHEM
IN201228430Medicaid