Provider Demographics
NPI:1619516077
Name:DOSSEY, NICOLE (BA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DOSSEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3758 CHITIMACHA TRL
Mailing Address - Street 2:
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544-8318
Mailing Address - Country:US
Mailing Address - Phone:337-578-1305
Mailing Address - Fax:
Practice Address - Street 1:825 CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-5500
Practice Address - Country:US
Practice Address - Phone:337-551-4630
Practice Address - Fax:337-551-4632
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty