Healthcare Provider Details

I. General information

NPI: 1053861195
Provider Name (Legal Business Name): ELIZABETH ANN SANDERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 3RD AVE
JASPER IN
47546-3602
US

IV. Provider business mailing address

949 MACARTHUR ST
JASPER IN
47546-2624
US

V. Phone/Fax

Practice location:
  • Phone: 812-634-6824
  • Fax: 812-481-1056
Mailing address:
  • Phone: 812-216-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28176153A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: