Provider Demographics
NPI:1144898792
Name:MUSE, SANDY ANN
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:ANN
Last Name:MUSE
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 1:2034 DYLAN DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4838
Mailing Address - Country:US
Mailing Address - Phone:985-774-5319
Mailing Address - Fax:985-201-7513
Practice Address - Street 1:4935 PIETY DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-3546
Practice Address - Country:US
Practice Address - Phone:985-774-5319
Practice Address - Fax:985-201-7513
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA94097892342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA94097892OtherNON EMERGENCY MEDICAL TRANSPORTATION