MS. SANDRA LEE BROMMELAND GONZALEZ (NPI# 1053428342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1053428342 |
Entity Type | Individual |
Full Name | MS. SANDRA LEE BROMMELAND GONZALEZ |
Credential | APRN-BC |
Practice Address |
1101 Audubon Ave Thibodaux LA 70301-4957 |
Mailing Address |
929 Bayou Dularge Rd Houma LA 70363-7614 |
Practice Telephone | 9858573615 |
Practice Fax Number | 9412957336 |
Mailing Telephone | 9858723550 |
Mailing Fax Number | 9412957336 |
Enumeration Date | 2006-08-24 |
Last Update Date | 2015-01-27 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP 5139 | LA | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
LA | 1022004 | 05 |
Street Address |
1101 AUDUBON AVE |
City | THIBODAUX |
State | LA |
Zip Code | 70301-4957 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275535148 | Thibodaux Laser and Surgery Center, LLC | Nurse Anesthetist, Certified Registered | 1101 Audubon Ave, Suite S4, Thibodaux, LA 70301-4957 | 2005-08-11 |
1316436199 | Richard L Arceneaux, Md LLC | Ophthalmology | 1101 Audubon Ave, Suite N-5, Thibodaux, LA 70301 | 2018-05-07 |
1184913451 | Psychiatric Solutions LLC | Clinic/Center | 1101 Audubon Ave, Thibodaux, LA 70301-4957 | 2011-04-07 |
1396063996 | Richard L. Arceneaux | Ophthalmology | 1101 Audubon Ave, Ste N-5, Thibodaux, LA 70301-4957 | 2010-05-07 |
1710219688 | Quentin D. Falgoust, Md, Amc | Eyewear Supplier (Equipment, not the service) | 1101 Audubon Ave, Ste N5, Thibodaux, LA 70301-4957 | 2010-02-03 |
1073609772 | Amy M. Johnson | Registered Nurse | 1101 Audubon Ave, Ste S-4, Thibodaux, LA 70301-4957 | 2006-10-04 |
1871603159 | Summer A. Bell | Licensed Practical Nurse | 1101 Audubon Ave, Ste S-4, Thibodaux, LA 70301-4957 | 2006-08-30 |
1174533798 | James Joseph Leonard | Urology | 1101 Audubon Ave, Sn3, Thibodaux, LA 70301-4957 | 2006-08-08 |
1083634133 | Becky M. Logan | Specialist/Technologist, Other | 1101 Audubon Ave, Ste S-4, Thibodaux, LA 70301-4957 | 2006-07-20 |
1205856325 | David W. Lindner | Registered Nurse | 1101 Audubon Ave, Ste S-4, Thibodaux, LA 70301-4957 | 2006-07-20 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1225539620 | Micah Aaron Callais | Nurse Practitioner | 604 N. Acadia Road, Suite 200, Thibodaux, LA 70301 | 2018-02-22 |
1982112348 | Katie Leblanc | Massage Therapist | 1115 St. Mary Street, Thibodaux, LA 70301 | 2018-01-18 |
1154837391 | Texas Digestive Disease Consultants, Pllc | Internal Medicine | 764 North Acadia Road, Suite A, Thibodaux, LA 70301 | 2017-12-26 |
1235648239 | Speech and Feeding Therapy, LLC | Speech-Language Pathologist | 1000 Plantation Rd Ste 1a, Thibodaux, LA 70301 | 2017-09-22 |
1285150466 | Tara Payne | Counselor | 303 Hickory Street, Thibodaux, LA 70301 | 2017-08-18 |
1427583475 | Tyler Pettigrew | Counselor | 300 Plantation Rd., Apt #24, Thibodaux, LA 70301 | 2017-04-27 |
1750825758 | Jessica Barquet | Counselor | 110 Palm Villa Dr Apt 1, Thibodaux, LA 70301 | 2016-12-09 |
1013468230 | Shenee Haas Gros | Counselor | 504 Cherry St., Thibodaux, LA 70301 | 2016-10-24 |
1982155388 | Southern Ent Associates Inc | Audiologist | 604 North Acadia Road Suite 101, Thibodaux, LA 70301 | 2016-10-20 |
1215483888 | Lesheeca Norman, Lpc | Counselor | 306 Victoria Court, Thibodaux, LA 70301 | 2016-09-01 |
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Taxonomy Code | 363LP0808X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Psych/Mental Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1346855517 | Ryan Michael Kelley | Nurse Practitioner | 126 Rue Colette, Thibodaux, LA 70301-5628 | 2020-09-14 |
1568931129 | Amanda Hussey | Nurse Practitioner | 303 Hickory St, Thibodaux, LA 70301-2011 | 2018-11-13 |
NPI | Name | Taxonomy | Address | Enumeration |
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1972113124 | Rebirth Mental Health Services LLC | Nurse Practitioner | 2116 Gause Blvd W Ste E, Slidell, LA 70460-4120 | 2020-08-03 |
1427668748 | Julie Susann Dyrek | Nurse Practitioner | 1 Lakeshore Dr Ste 1830, Lake Charles, LA 70629-0114 | 2020-08-01 |
1376169979 | Nancy Ariwodo | Nurse Practitioner | 225 Rue La France, Lafayette, LA 70508-1565 | 2020-06-19 |
1578183208 | Donald Glyn Gardner II | Nurse Practitioner | 324 Blue Fox Cir, Haughton, LA 71037-7707 | 2020-04-22 |
1629604129 | Raelyn Marie Plauche | Nurse Practitioner | 1951 Florida Ave Sw Ste D&e, Denham Springs, LA 70726-4947 | 2020-03-16 |
1962035964 | Tyler Trenton Wansley | Nurse Practitioner | 23515 Us-190, Mandeville, LA 70448 | 2020-02-18 |
1114558715 | Danielle J Threatts Aprn LLC | Nurse Practitioner | 208 W Gloria Switch Rd Ste 219, Lafayette, LA 70507-3409 | 2020-02-01 |
1992359848 | Harold G Frizzell Psychiatric Services LLC | Nurse Practitioner | 300 Thompson Loop, Lafayette, LA 70506-2820 | 2019-07-29 |
1598227779 | Candyce Brown | Nurse Practitioner | 333 Dr Michael Debakey Dr Ste 220, Lake Charles, LA 70601-5888 | 2019-04-04 |
1659835346 | Cassandra Thomas-jingles Psychiatric Nurse Practitioner, LLC. | Nurse Practitioner | 156 Mcgehee Dr, Baton Rouge, LA 70815-5012 | 2019-01-26 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.