Provider Demographics
NPI:1588542518
Name:GUILLORY, SUSANNA (REG NURSE)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:REG NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 HEATHERBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-6742
Mailing Address - Country:US
Mailing Address - Phone:409-719-2160
Mailing Address - Fax:409-237-5167
Practice Address - Street 1:8220 HEATHERBROOK TRL
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6742
Practice Address - Country:US
Practice Address - Phone:409-719-2160
Practice Address - Fax:409-237-5167
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582647171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator