Provider Demographics
NPI:1548540784
Name:GUILES, KATHLEEN (LMT, RN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:GUILES
Suffix:
Gender:F
Credentials:LMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RAVENS RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-9203
Mailing Address - Country:US
Mailing Address - Phone:505-989-7635
Mailing Address - Fax:
Practice Address - Street 1:1532 CERRILLOS RD
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3512
Practice Address - Country:US
Practice Address - Phone:505-986-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR36964163W00000X
NM5318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse