Provider Demographics
NPI:1235661570
Name:MICHAUD-MESIDOR, GUILAINE
Entity type:Individual
Prefix:
First Name:GUILAINE
Middle Name:
Last Name:MICHAUD-MESIDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GUILAINE
Other - Middle Name:
Other - Last Name:MICHAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 740021
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0021
Mailing Address - Country:US
Mailing Address - Phone:773-352-1519
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:1000 S ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3100
Practice Address - Country:US
Practice Address - Phone:908-737-5703
Practice Address - Fax:908-325-0075
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00717000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily