| Doctor Name: | MS. SANDRA LEE BROMMELAND GONZALEZ |
| NPI Number: | 1053428342 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN-BC |
| License Number: | AP 5139 |
| Business Practice Address: | 1101 Audubon Ave Thibodaux, LA - 703014957 |
| Business Phone Number: | 9858573615 |
| Business Fax Number: | 9412957336 |
| Mailing Address: | 929 Bayou Dularge Rd, HOUMA |
| State: | LA |
| Postal Code: | 703637614 |
| Phone Number: | 9858723550 |
| Fax Number: | 9412957336 |
| NPI Enumeration Date: | 08/24/2006 |
| NPI Last Update Date: | 01/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | AP 5139 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |