Provider Demographics
NPI:1558718361
Name:PRINCE, SANDRA ELAINE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELAINE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PRATT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2546
Mailing Address - Country:US
Mailing Address - Phone:504-912-7465
Mailing Address - Fax:
Practice Address - Street 1:55 PRATT DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-2546
Practice Address - Country:US
Practice Address - Phone:504-912-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator