Provider Demographics
NPI:1306888466
Name:NEIL, SANDI P (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:P
Last Name:NEIL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W TUNNEL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5555
Mailing Address - Country:US
Mailing Address - Phone:985-851-1717
Mailing Address - Fax:985-851-7183
Practice Address - Street 1:809 W TUNNEL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5555
Practice Address - Country:US
Practice Address - Phone:985-851-1717
Practice Address - Fax:985-851-7183
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01224363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1662470Medicaid
LA1662470Medicaid
5X378Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER
191848Medicare ID - Type UnspecifiedFQHC PROVIDER NUMBER