1619281565 NPI number — MS. SANDRA EXNICIOUS SUMLER MSW

Table of content: MS. SANDRA EXNICIOUS SUMLER MSW (NPI 1619281565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619281565 NPI number — MS. SANDRA EXNICIOUS SUMLER MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUMLER
Provider First Name:
SANDRA
Provider Middle Name:
EXNICIOUS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619281565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 WESTBANK EXPY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARRERO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70072-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-349-8708
Provider Business Mailing Address Fax Number:
504-349-8703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 WESTBANK EXPY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARRERO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-362-0221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1986704 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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