Individual
MS. SANDRA LEE BROMMELAND GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-BC
Contact information
Practice address
1101 AUDUBON AVE, THIBODAUX, LA 70301-4957
(985) 857-3615
(941) 295-7336
Mailing address
929 BAYOU DULARGE RD, HOUMA, LA 70363-7614
(985) 872-3550
(941) 295-7336
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP 5139
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022004
—
LA
Enumeration date
08/24/2006
Last updated
01/27/2015
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