=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083841712
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANDRIA T WILEY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2009
-----------------------------------------------------
Last Update Date | 06/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4018 MAGAZINE ST
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70115-2749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-897-9200
-----------------------------------------------------
Fax | 504-897-9234
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 182 HANNIBAL CT
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39530-3916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-324-9236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP05810
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------