Provider Demographics
NPI:1902295017
Name:THOMAS, SHANDRA TRE'NISE
Entity Type:Individual
Prefix:
First Name:SHANDRA
Middle Name:TRE'NISE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANDRA
Other - Middle Name:TRE'NISE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:1402 S MAGNOLIA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5020
Mailing Address - Country:US
Mailing Address - Phone:985-247-4567
Mailing Address - Fax:985-269-7091
Practice Address - Street 1:1402 S MAGNOLIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5020
Practice Address - Country:US
Practice Address - Phone:985-247-4567
Practice Address - Fax:985-269-7091
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily