Provider Demographics
NPI:1538141361
Name:DEJEAN, GUERLINE PAUL (NP)
Entity type:Individual
Prefix:
First Name:GUERLINE
Middle Name:PAUL
Last Name:DEJEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 S LOOP W
Mailing Address - Street 2:STE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5632
Mailing Address - Country:US
Mailing Address - Phone:832-265-6522
Mailing Address - Fax:713-349-9887
Practice Address - Street 1:2656 S LOOP W
Practice Address - Street 2:STE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5632
Practice Address - Country:US
Practice Address - Phone:713-728-6734
Practice Address - Fax:713-728-6735
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610758363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165420401Medicaid
TX8B6487Medicare PIN