Provider Demographics
NPI:1992812374
Name:SOILEAU, SIMMIE (NP)
Entity type:Individual
Prefix:
First Name:SIMMIE
Middle Name:
Last Name:SOILEAU
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 1:609 RUE DE BRILLE
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2123
Mailing Address - Country:US
Mailing Address - Phone:337-560-1144
Mailing Address - Fax:337-560-1102
Practice Address - Street 1:609 RUE DE BRILLE
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2123
Practice Address - Country:US
Practice Address - Phone:337-560-1144
Practice Address - Fax:337-560-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1502596Medicaid
LA1502596Medicaid
LAQ40871Medicare UPIN