Healthcare Provider Details

I. General information

NPI: 1750581492
Provider Name (Legal Business Name): MICHELLE SANDERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 ROSALINE AVE
REDDING CA
96001-2509
US

IV. Provider business mailing address

21292 CREEKSIDE DR
RED BLUFF CA
96080-9615
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number17397
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: