Provider Demographics
NPI:1982387064
Name:SANDOLPH, LORIEAL LACHELLE (RN)
Entity Type:Individual
Prefix:
First Name:LORIEAL
Middle Name:LACHELLE
Last Name:SANDOLPH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 FULVETTA FALLS RD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5242
Mailing Address - Country:US
Mailing Address - Phone:504-547-1142
Mailing Address - Fax:
Practice Address - Street 1:609 METAIRIE RD # 8279
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4034
Practice Address - Country:US
Practice Address - Phone:150-454-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver