Provider Demographics
NPI:1720829203
Name:VEAL, WILLIE
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:VEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:WILL
Other - Middle Name:MEDICAL
Other - Last Name:COURIER LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3109 PHOENIX ST APT A
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-5128
Mailing Address - Country:US
Mailing Address - Phone:504-214-5465
Mailing Address - Fax:
Practice Address - Street 1:3109 PHOENIX ST APT A
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-5128
Practice Address - Country:US
Practice Address - Phone:504-214-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171W00000X, 172A00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver