Provider Demographics
NPI:1245727387
Name:SUMLER, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SUMLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:MARIE
Other - Last Name:SUMLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1339 LIZARDI ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-3625
Mailing Address - Country:US
Mailing Address - Phone:150-423-2233
Mailing Address - Fax:
Practice Address - Street 1:1829 CARONDELET ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5207
Practice Address - Country:US
Practice Address - Phone:504-232-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA821863330OtherINTERNAL REVENUE