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General NPI Number Information
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NPI Number | 1548537269
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Entity Type | Individual
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Provider Name | SANDY HEIDEL BOCKLUD NNP
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Gender | Female
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 18951 N MEMORIAL DR
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City | HUMBLE
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State | TX
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Zip | 77338-4217
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Country | US
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Telephone | 281-540-7806
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Fax |
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Provider Business Mailing Address
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Address Line | 219 DELTA DR
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City | MANDEVILLE
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State | LA
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Zip | 70448-7570
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Country | US
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Telephone | 985-789-0108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 1095084
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License Number State | TX
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