Provider Demographics
NPI:1326724717
Name:SUNTREE MEDICAL CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:SUNTREE MEDICAL CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:337-643-8424
Mailing Address - Street 1:304 E VETERANS MEML DR
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-5009
Mailing Address - Country:US
Mailing Address - Phone:337-643-8424
Mailing Address - Fax:337-643-8407
Practice Address - Street 1:428 LAKESHORE VLG E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5648
Practice Address - Country:US
Practice Address - Phone:504-343-3655
Practice Address - Fax:337-643-8407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAUNTRICE O'QUIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty