MEDICARE: NISSI SEALS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor	010029392	LA

General Provider Information

NPI Number	:	1205799632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISSI SEALS

Provider Business Mailing Address
First Line	:	1619 MARY ELLEN DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-1438
Country	:	US
Telephone Number	:	504-266-6760
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 MARY ELLEN DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-1438
Country	:	US
Telephone Number	:	225-476-1546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ NISSI SEALS ” Practice Location

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