1033132600 NPI number — SANDRA J CAPPS APRN, RN

Table of content: SANDRA J CAPPS APRN, RN (NPI 1033132600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033132600 NPI number — SANDRA J CAPPS APRN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAPPS
Provider First Name:
SANDRA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, RN
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:
1033132600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70404-2668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-230-1682
Provider Business Mailing Address Fax Number:
985-230-1617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15790 PAUL VEGA MD DR
Provider Second Line Business Practice Location Address:
REVENUE MANAGEMENT DEPARTMENT
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-230-1682
Provider Business Practice Location Address Fax Number:
985-230-1617
Provider Enumeration Date:
07/25/2006

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: 163W00000X , with the licence number:  RN028487 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP01147 , 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: 1686051 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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