Basic Information
| Provider Information | |||||||||
| NPI: | 1114272325 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANDERS NURSE ANESTHESIA SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9900 E 570 RD | ||||||||
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| City: | CATOOSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740156294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183440807 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9308 S TOLEDO AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741372739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187288020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2012 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | SANDERS | ||||||||
| AuthorizedOfficialFirstName: | LAVONNA | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9183440807 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.