Provider Demographics
NPI:1639759657
Name:GUERRIER, ISMAELLE
Entity type:Individual
Prefix:
First Name:ISMAELLE
Middle Name:
Last Name:GUERRIER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ISMAELLE
Other - Middle Name:
Other - Last Name:GUIGNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:458 LINCOLN ST APT 11
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4141
Mailing Address - Country:US
Mailing Address - Phone:781-308-3623
Mailing Address - Fax:
Practice Address - Street 1:HCRC
Practice Address - Street 2:170 MORTON ST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-541-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN93418164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALN93418OtherMA LPN LICENSE