Individual
MR. DALE MICHAEL SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
8300 CONSTANTIN BLVD, BATON ROUGE, LA 70809-3489
(225) 374-4325
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-5727
(225) 765-4278
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
AP06807
LA
363LN0000X
Neonatal Nurse Practitioner
TAP002754
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2190598
—
LA
01
—
PENDING
BCBS LA
LA
Enumeration date
01/31/2012
Last updated
10/08/2020
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